NEW OFFICES OPEN!! Accepting registration for Psychiatry and Medication Management.

Santa Rosa Counseling Center
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Santa Rosa Counseling Center
  • Home
  • Services
  • Clinicians
  • Forms
  • Schedule Online
  • Contact
  • For Couples

Registration Forms

Please print and bring completed forms to your first session.

 Complete an Authorization for Release of Information form for all medical providers.

New Patient Registration, Full Packet (pdf)Download
New Patient Registration (pdf)Download
Informed Consent (pdf)Download
Financial Policy (pdf)Download
Authorization for Release of Information (pdf)Download
Controlled Substance Agreement (pdf)Download
Telehealth Policy Packet (pdf)Download

Miscellaneous

Referral (pdf)Download
Sliding Fee Schedule Program (pdf)Download

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