Records Release Consent | We respect your privacy. In order to share your confidential information with anyone, we must have your written consent on file.
Sliding Fee Scale Form | This document provides sliding fee scale in addition to Sliding Fee Agreement between client and counselor/Family Concern Counseling.
Scholarship Application | In order to qualify for our Scholarship Program, you must first apply. Upon approval of your application, call 219-477-5646 for an appointment to determine the scholarship amount.
Select the PayPal Icon to make your payment.
There are two options if you wish to pay by Personal Check
1.) You can drop off your check, in person, during normal business hours.
2.) You can mail your Personal Check to:
Family Concern Counseling
Attn: Payment Department
2004 Valparaiso Street
Valparaiso, IN 46383
Cash Payments are accepted in person only (please do not mail cash)
Cash Payments can be made Monday through Friday during normal business hours. [9am—5pm M—F]
FCC strives to provide quality counseling regardless of socioeconomic status. The fee schedule below is to serve as a guideline for you and your counselor. However, if you have extenuating circumstances, further financial arrangements can be made with your counselor.
This schedule reflects the charge for a regular counseling session based on monthly household income.
After installing Adobe Reader, select links to download or Right Click and Save As to your computer’s documents folder. You can type your information right onto the form or print it out and complete the old fashioned way and bring it with you to your first/next session.
Please call 219-477-5646 if you have any problems or questions regarding these forms.