Client Forms

Fallon Family Wellness Center Client Forms

We truly admire you for taking this first step toward making lasting, positive change in your life. At your first visit, we want to focus on you, not paperwork, so we’ve provided all necessary forms for you to fill out beforehand. Please print and fill out ALL forms that apply to you and email them or drop them off at our box @ 2040 Reno Hwy #400. If you have any questions, please give us a call at (775) 423-3392

FFWC ADULT INTAKE FORM 2023

FFWC MINOR INTAKE FORM 2023

If you feel that you would like to collaborate your session with another provider, simply fill out the following form.

Consent Release

 

Contact Today



2040 Reno Hwy #400,
Fallon, NV 89406

ffwc@fallonfamilywellnesscenter.com
(775) 423-3392

Got Questions?
Send a Message!

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.