EMAIL US AT info@tmcc.org
CALL US NOW (310) 271-9999
Donate Now

Adolescent Child Therapy Intake Forms

Adolescent/ Child Therapy Intake Forms

*Before completing forms please call our Intake line at (310) 271-9999 x3 and leave a message with your contact information and what type of service you are seeking.  A counselor will call you back and they will direct you as to which forms need to be completed.

 

 To submit application please:

  1. Complete Child/ Family Information and History Form below.
      • Please complete all *required fields for the ‘Submit’ button to appear at end of the form. 
      • Once submitted a digital copy will be sent to your email for your reference.

 

2. Complete Parent/ Guardian Forms below (a digital signature is required)

      • Please complete all *required fields for the ‘Submit’ button to appear at end of the form. 
      • Once submitted a digital copy will be sent to your email for your reference.

 

Or: Download PDF application (button below), print, sign, scan and email completed application to intake@tmcc.org

Additional option: Call our office to receive application by mail and once completed mail back to TMCC. 

Subscribe

Sign up today to receive Maple News, event updates, and more.

We respect your privacy.