Pre-Registration Form


We understand what it’s like to watch your child struggle at home, at school and in the community. Just like you, our dedicated professionals want the best for them. Whether your child lives with anxiety, depression, ADHD or another mental health issue, Family Service & Guidance Center is here to assess what’s going on and provide the appropriate treatment.

Pre-registration is the quickest, easiest way to get started. Once you complete and submit the pre-registration form, an FSGC staff member will be in touch soon by phone to arrange your first appointment.

Complete the information below. Be sure to click "Submit" to send your form to us. FSGC Admissions will contact you to set up your appointment. (NOTE: An asterisk * indicates required information.)

Insurance Information

Add your primary insurance company policy information below.

Add your second insurance company policy information below.

Add your third insurance company policy information below.

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Did you know?

The FSGC Foundation was formed in 2009 to ensure the agency’s long term viability, regardless of funding cuts or other economic uncertainties. Each year, the Foundation awards thousands of dollars in needed funds to improve and enhance various FSGC services and programs.