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
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
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
Contact
2140 Eastman Avenue, Suite 112
Ventura, CA 93003
Call:
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