Privacy Practices

The Marriage and Family Resource Center Privacy Practice form describes how medical information about you may or may not be used and disclosed, and how you can get access to this information. Please review it carefully, sign it, and present it at your first appointment.
Download the Privacy Practices Form

Release Form

The Release Form provides authorization to The Marriage and Family Resource Center to release records to designated third parties such as other doctors, attorneys and spouses. In short, MRC will keep your records, but you have the power to decide where the information goes. Please review it carefully, sign it, and present it at your first appointment.

Intake Form

The intake form is the initial application required to be treated at the Marriage and Family Resource Center. Please download, review it carefully and fill it out completely prior to your first appointment.
Download the Intake Form

Insurance Claim Form

An insurance claim is the actual application for benefits provided by an insurance company. Policy holders must first file an insurance claim before any money can be disbursed to the Marriage and Family Resource Center or other contracted service. The insurance company may or may not approve the claim, based on their own assessment of the circumstances.