Referral Forms
To refer a client to FHN Family Counseling Center, please complete and submit the FHN Family Counseling Center Consultation and Referral Form along with any relevant information pertaining to your referral.
For additional information on making a referral, please see the FHN Family Counseling Center Referral Guide.
Additional referral forms:
- FHN Family Counseling Center Authorization to Release/Obtain Protected Health Information
- Welcome to FHN Family Counseling Center handout for clients
- Hamilton Anxiety Rating Scale
- Beck Depression Inventory
- Edinburgh Postnatal Depression Scale (EPDS)
- Center for Epidemiological Studies Depression Scale for Children (CES-DC)
- Screen for Child Anxiety Related Disorders (SCARED)
If you are a provider and would like copies of the above forms to administer and refer, please contact our office at 815-599-7300.


