Intake Form - Adults
Please print this form and complete it if you will be seeing one of our Therapists or Counselors, other than Dr. Timothy Heck.
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Intake Form - Minors
This Intake Form is specifically if the patient being seen at FCA is a minor, under the age of 16.
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Intake Form for Drs Heck and Davis
Please use this Intake Form if you will be seeing Dr. Timothy Heck for therapy.
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Intake Form for Dr. Abram
Please use this Intake Form if you will be seeing Dr. Abram for psychiatric services.
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Intake Form for Dr. Cecil
Use this Intake Form if you will be seeing Dr. Cecil for psychiatric services.
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Minor Consent Form for Dr. Davis
Please sign this form for your child or adolescent who will be seeing Dr. Jama Davis for the first time and bring to the first session.
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Minor Form for Dr. Davis
Use this form if your child or adolescent will be seeing Dr. Jama Davis for the first time. Complete the form and bring to our office on your first visit.
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Release of Information Consent Form
This form is for you to complete if you would like your provider to consult with another provider or individual about your case. It will need to be signed by a witness who is over 18.
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Health History Questionnaire
This is a Health History Questionnaire that your provider may want you to complete as part of the Assessment process for your care.
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AACC Code of Ethics
This file contains a pdf version of the Code of Ethics for the American Association of Christian Counselors. The professionals at FCA maintain practice standards according to this Code of Ethical Conduct.
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Application for Employment
The attached application is designed for clinical therapists and residents.
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Jama Davis Research
Alone in a Crowd: A Phenomenological Inquiry into Loneliness as Experienced by Pastors' Wives
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