To get started with us, click one of the forms below. The initial intake form is intended for potential clients 15 and older and the child intake form is for those 14 and under. Once the form has been filled out, please email, mail, or fax the completed form to services@flrc.org with a copy of your photo ID and insurance card.   

**Please call the office at (540) 434-8450 to ask questions or check our availability.**

Intake Forms

Initial Intake Form

Initial Child Intake Form

Couples Intake Form