Counseling & Human Development Center (CHDC) and Child & Family Resource Clinic (CFRC)
Counseling Intake Forms
Client Information Form - all fields with an asterisk are required.
WARNING: If this is an emergency, call 911 immediately.
Please enter your personal information below.
Are you an existing client?
*
Yes
No
Client First Name:
Please enter only your given first name
*
Client Last Name:
*
Client Date of birth:
*
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