home  
  about us  
  OUR PROVIDERS  
  INDIVIDUALS  
  COUPLES  
  FAMILIES  
  CHILDREN & TEENS  
  SERVICIOS EN ESPAÑOL  
  contact us & locations  

Welcome to FBTA! We are happy you're here.


Client Intake Forms

Please call one of our convenient office locations to set up an appointment before filling out paperwork. If you have an active email address, intake paperwork can be filled out electronically through our secure online system. Please contact an Office Manager for more information.

If you are unable to complete the intake forms ahead of time, please arrive 15-20 minutes early. Forms will be available to you when you arrive at the clinic. If you are coming in as a couple, note that each of you are to fill out your own set of forms. 



If you prefer to print paperwork and complete it before your appointment, click on a form title to open a Microsoft Word document of that form. You may complete the form by word processing or by handwriting in the requested information. Please bring these to your first session.

Please note: All forms are in Microsoft Word 97-2003 format.  If you do not have access to Microsoft Word, you can download a free version of Open Office by clicking HERE.

Please bring the Intake Paperwork, Consent for Treatment, and Release for Primary Care Physician forms to your first appointment.

ALL PATIENTSCHILD/ADOLESCENT PATIENTSFOR YOUR REFERENCEFOR ADD/ADHD PATIENTS
Insured Information & Consent for Treatment
Consent for Treatment (Download File)

Client/Insured (Download File)

Physician Release
Download File
(word processing version)
Download File
(handwritten version)

Protected Health Information (PHI) Release
Download File
(word processing version)
Download File
(handwritten version)
Diagnostic Assessment
Download File


click here



 




Click here for our insurance and fee information.




It is during our darkest moments that we must
focus to see the light.
 
- Aritotle Onassis



Call for an appointment at one of our three
convenient locations:

Coon Rapids  |  763-780-1520
Cambridge  |  763-689-9407
Chisago City  |  651-257-2733

»  locations and directions



FAMILY BASED THERAPY ASSOCIATES
Convenient locations near you.
Coon Rapids Office
199 Coon Rapids Blvd.
Suite 306
Coon Rapids, MN  55433

Cambridge Office
Courthouse Square
237 SW 2nd Avenue
Suite 117
Cambridge, MN 55008
Chisago City Office
11549 Lake Lane, Suite 2
Chisago City, MN  55013

http://www.webaloo.com