Family Therapy Inquiry Form Are you or a family member an existing client with CTC? Yes No In-Office or Tele-Therapy? * In-office Tele-therapy How many people will be participating? What are the ages of participants? Person 1 * First Name Last Name Person 1 Email * Person 1 Phone * (###) ### #### Person 2 * First Name Last Name Person 2 Email * Person 2 Phone * (###) ### #### Please provide the names, ages, and contact information of any other family members that will be participating: Do you want to use insurance? * Yes No Message: Is there anything you'd like us to know to help us match you with a therapist? Do you have any scheduling limitations? Thank you!
