Child/Adolescent
Application:
You may obtain a
child/adolescent application from the clinic, located on the
2nd floor of the Regional Rehabilitation Building, or by downloading
one from this site.
There are three parts
to the child application for services. The child or adolescent’s
parents generally complete all parts.
One part is the application
itself, which can be obtained from clicking on the following
link: childapp.pdf.
The second part is
the “FSU Psychology Clinic Income Information”. This
information asks about your income and dependents and requires
the signature of a witness (and/or notary public). Although
you need to complete this form, please note that you DO NOT
have to get a witness or a notary public. Office staff will
handle witnessing the application for you. The FSU Psychology
Clinic Income Information form can be obtained by clicking
on the following link: fees.pdf.
The third part is
the Consent for Taping, Observation, and
Research Participation form. For more information about
this form, please click on the active link. The Consent for
Taping, Observation, and Research Participation form can be
obtained by clicking on the following link: obsrvconsent.pdf.
If you decide to
apply to our clinic for services, there is a $25 fee for the
application process. If you are coming for family therapy, the
fee is $35. For more information on the application process
see application process.
