2140 Eastman Avenue, Suite 112, Ventura, CA VCC@VenturaCommunityCounseling.com 805-791-9700

Forms

Please use the following forms for your first appointment with your VCC Clinician.

If you’re an adult client, please click on the following forms to download. Fill them out and bring them in to your first appointment.

Adult Intake Form

VCC Consent to Treatment

 Fee Agreement and Cancellation Policy

Debit/Credit Card Authorization Form

If you’re the parent or guardian signing on behalf of a child or adolescent client, please click on the following forms to download. Fill them out and bring them in to your child’s first appointment.

Child Adolescent Consent to Treat

Child Adolescent Intake

Fee Agreement and Cancellation Policy

Debit/Credit Card Authorization Form

Los siguientes formularios están en español. Por favor, llénelos y tráigalos a su primera cita.

Spanish Consent to Treat – Consentimiento al Tratamiento

Spanish Fee Agreement and Cancellation Policy – Acuerdo Financiero y Politica de Cancelacion

Spanish Adult Intake Form – Formulario de Entrada