Client Forms
Please find the appropriate form for your needs and complete them prior to your intake session. Feel free to call with any questions.
If you are mandated/court ordered client you must include a Release of Information for all parties in the case (PO, DHS, attorney, etc.)
New Client Information
Other Forms
Sliding Scale
The mountain community has a variety of income levels and financial means. Therefore Family Integration Counseling Service, Inc. offers discounts on mental health care based on your personal income.
Total Gross Annual Family Income per Family/Individual Therapy Session
$ under $34,999 ………………………………………………………. $50.00
$35,000 – $49,000………………………………………………………. $65.00
$50,000 and Above…………………………………………………….. $80.00
Sliding Scale for Mandated Clients
Total Gross Annual Family Income per Family/Individual Therapy Session
$34,999 and Below …………………………………………………….. $50.00
$35,000 – $49,000………………………………………………………. $75.00
$50,000 and Above…………………………………………………….. $85.00
Due to the level of overhead (contact with probation, report writing, etc) higher prices are required for any treatment mandated by the courts. Clients may be charged in addition for services that exceed usual and customary contact. Examples of such services would include court attendance, staff meetings, assessments, etc.
