New Client Registration – Connie Dummer

The link below will take you to our preregistration form. The forms are hosted by another site, but the site is secure, so your information will be protected.

https://www.therasoftonline.com/tms/PreRegistration.aspx?companycode=FACC

After you submit the preregistration, links to some additional forms will appear. Please print, complete, and bring forms #2, 3, and 5 with you. The other forms are for your information only, you do not need to bring them. Feel free to contact Todd Nichols with any questions.

In addition to completing the preregistration using the link above, new clients for Connie please download and complete the appropriate form below:

Child/Adolescent form (new clients for Connie ONLY)
Adult form (new clients for Connie ONLY) (link to Adult Intake Form)