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Services

To sign up or make an appointment for counseling in Orange County, go to 


  • Individual, Family Counseling, and Crisis Counseling
  • Individual Personal Empowerment Sessions for Women
  • Couples Counseling -- Marital, Pre-marital, Conjoint
  • Parent/Child Counseling
  • Family Counseling
  • Co-parenting Counseling
  • Adult Children of Divorce Counseling
  • Reunification Counseling: Parent/Child


  • Parenting Classes
  • Co-parenting Classes
  • Anger Management
  • Parent & Teen Empowerment


  • Monitored/Supervised Visits
  • Supervised Exchanges


 DATE:

 

 

TIME:

 

RECEIVED BY:

 

TYPE OF SERVICE:  ask for COURT ORDER; arrive 15 min early

               COUNSELING

¨  INDIVIDUAL COUNSELING

¨  CONJOINT or CHILD(REN) COUNSELING

¨  CO-PARENTING COUNSELING

¨  FAMILY/COUPLES COUNSELING

¨  REUNIFICATION (INITIAL INTAKE & 4 SESSIONS)

      

     GROUP CLASSES

¨  PARENTING I (16 WEEKS)

¨  PARENTING II (26 WEEKS)

¨  CO-PARENTING CLASSES (16 WEEKS)

¨  ANGER MANAGEMENT CLASSES (26 WEEKS)

¨  TEEN ANGER MANAGEMENT CLASSES (10 WEEKS)

¨  RELAPSE PREVENTION

 

 

     GROUP CLASSES CONT’D

¨  TRUANCY PREVENETION PEP-Parent & Teen (6 WEEKS)

¨  CHILD’S GROUP (Kids under 12 only)

 

MONITORED VISITS & SAFE EXCHANGES

¨  CUSTODIAL PARENTS INTAKE ORIENTATION

¨  NON-CUSTODIAL PARENTS INTAKE ORIENTATION

 

¨  OTHER: _________________________________

 

IS THERE A COURT ORDER ASSOCIATED WITH THIS REQUEST?

¨  YES (Must provide FACES with a copy of court order)

¨     NO   (IF “NO”, PROCEED BELOWê)

___  COPY OF COURT ORDER (MUST HAVE PRIOR TO SCHEDULING)

___ COMPLETE ALL INFORMATION BELOW IN SHADED AREAS

 

LOCATION OF SERVICES REQUESTED:

¨ FULLERTON     ¨ SANTA ANA     ¨ LAGUNA HILLS     ¨ EL MODENA   OTHER: __________________

Referred by_______________________

COURT- CSP-PROBATION DEPT.-SCHOOL

MONTHLY INCOME:                                                       Registration/Intake Fee: $50.00 (One-time Non-Refundable fee)

Client:                                                                              Reunification Fee: $250.00 (5 sessions) $1000 for 20 sessions/report upon

Spouse/Other Parent:                                                    Session/Class Fee:

                                                                                         Supervised/Monitored Visit: $95/ 2.5 hours /Exchange Fee: $30.00

CLIENT/ADULT NAME:                                                                                                             DOB:                                    ¨MALE   ¨ FEMALE

Custodial / Non-Custodial Parent

CHILD 1 NAME:                                                                                                                         DOB:                                   ¨MALE   ¨ FEMALE

CHILD 2 NAME:                                                                                                                          DOB:                                   ¨MALE   ¨ FEMALE

CHILD 3 NAME:                                                                                                                          DOB:                                   ¨MALE   ¨ FEMALE

ADDRESS:

HOME PHONE:

CITY                                               STATE               ZIP

WORK PHONE:

SOC WRKER /PROB OFFICER /ATTORNEY (Circle one)

NAME :                                           

 

PHONE:

 

EMAIL:                                                       FAX:

PHONE:

E-mail:

 

Availability (Mother):

Availability (Father):

COUNSELOR/GROUP FACILITATOR/MONITOE ASSIGNED:                                      SCHEDULED DATE:                          TIME:

 

English _____ Spanish_____   Other: _____________*Remind client to come 15-20 minutes before appt. time in order to complete paperwork   

Spouse/Other Parents Information: Custodial / Non-Custodial Parent

NAME:                                                                    DOB:

EMAIL:

CITY                                       STATE               ZIP                    

WORK PHONE (          

ATTORNEY                                                  PHONE (      )