Before setting an appointment, patients will complete and return intake forms to our office. Separate forms are provided for children/adolescents and adults and can be downloaded below. A physician/specialist referral form is also available for download on this page. Please view our Privacy Practices Notice (see below for link) before completing the intake packet. After we receive your completed intake packet, you will be notified to arrange an initial/intake appointment.
For your convenience, you may download intake forms below. If you would prefer, you can choose to pick up these forms in our office and complete them in the comfort of our waiting room. When finished, simply turn in the completed forms to our office staff.
If you have any questions, feel free to call us at (870) 743-6225!
FPC provides a range of assessment and therapy services for children and adolescents, including testing for learning disorders, ADHD, disruptive and defiant behaviors, intellectual delays, autism spectrum disorder, depression, anxiety, and family conflict issues. Often these problems are best treated with parent and family involvement in therapy. If you are the parent or guardian, you may download and complete the intake form for your adolescent or child, and drop it by or mail to our office. The Patient Notice of Privacy Practices form (available below) must also be, printed, signed and included with the Child/Adolescent Intake Form.
Child and Adolescent Therapy
Adult and Couples Therapy
Our adult clients present with a range of presenting issues, including depression, grief and bereavement, parenting issues, employment conflicts, traumatic memories, panic attacks, obsessive-compulsive disorder, marital conflict, and life transitions. Psychological evaluations as well as individual therapy and family therapy are provided. The Patient Notice of Privacy Practices form (available below) must also be, printed, signed and included with the Adult Intake Form.
Patient Notice of Privacy Practices
Setting an Appointment - Intake Forms
Protecting client confidentiality is an essential component of building trust and stimulating growth. The parameters of confidentiality are explained to clients in detail at the outset of initial appointments and are outlined in the Patient Privacy Notice, which is available by clicking on the "Privacy Practices" link above. As a requirement of HIPAA, all new patients must complete this form. Please print, sign, and include with your intake form.
Physician/Specialist Referral Form
Please complete this downloadable form to refer your patient and fax to our office (870-743-6006) to arrange for psychological services. At your request, we can also provide you with hard copies of our referral form in a convenient notepad form. We appreciate the privilege of working with your valuable patients! Please call us if you have any questions about referring a new patient.
Family Psychological Center, P.A.
623 North Walnut Street
Harrison, AR 72601
Confidential Services in a Family-Centered Atmosphere