Forms

In order to schedule your first meeting, please print and complete the PDF forms below. Yes, it's a hassle! And...no way to do this in person right now, so we'll have to muddle through online.

1.  Intake form, either child or adult.  Both parents must sign to show their consent for care for any minor to participate in therapy at CFCG.

2.    Office Policies, signed by both parents.

3.    Child Information Questionnaire

4.    Telemedicine Informed Consent

5.    Health Questionnaire

A release form will only be necessary if the parents and therapist agree a consultation with another professional is appropriate.

You can choose the most convenient way to return forms to Marté Matthews: e-mail, fax, mail or drop them through the mail slot at our office. Your therapist will then call or email you to schedule your first meeting.

Questions? Marté is available by phone or email to help. info@childfamilygroup.com

Please note that Child & Family Counseling Group, Inc. is a private organization and we are not a crisis center.  
 

​If you or your child is currently experiencing a crisis in which anyone is feeling unsafe, please contact:

Uplift Child & Adolescent Mobile Crisis at 408-379-9085
Alum Rock Child & Adolescent Mobile Crisis at 408-294-0579
Suicide & Crisis Hotline at 855-278-4204

 

In case of life-threatening emergency, call 911 or go to the nearest hospital emergency room.

Other resources for help in a crisis

Bill Wilson Center SOS Crisis Hotline 408-278-2585
BWC’s SOS Crisis Hotline is a specialized line answering calls 24/7 from parents, teachers, and community support persons for children and youth who are experiencing an immediate behavioral or mental health escalation or crisis. They provide an urgent phone or in-person response to help de-escalate and stabilize the situation.

Domestic Violence 1-800-799-SAFE (7233)
https://www.thehotline.org/help/
Advocates are available 24/7 in more than 200 languages. All calls are free and confidential.

National Eating Disorders Association Helpline (800) 931-2237
https://www.nationaleatingdisorders.org/help-support/contact-helpline
Contact the Helpline for support, resources and treatment options for yourself or a loved one.
Helpline Phone hours are Monday-Thursday from 11AM to 9PM ET, and Friday from 11AM to 5PM ET.
Helpline Chat hours are Monday-Thursday from 9AM to 9PM ET and Friday 9AM to 5PM ET.
Helpline volunteers are trained to help you find the information and support you are looking for. Reach out today!

National Parent Helpline:  1-855-427-2736

24/7 Teenline for Youth: 1-888-247-7717

Santa Clara County Mobile Crisis Response (for adults in crisis) 1-800-704-0900

Crisis Textline text HOME to 741741
www.crisistextline.org

© 2020 by Child & Family Counseling Group, Inc.