Forms
Please complete the required forms requested by the OSHCC Intake Coordinator and/or the Therapist. Once complete, please email them to https://sendsafe.to/ohsccenter@gmail.com or fax them to 1-866-898-9031. If additional forms are requested, the Coordinator or Therapist will provide them.
- Authorization for release of information
- Referral Form
- Client Intake Form
- Counseling Center Consent
- Self-care Assessment
- Five Love Languages Assessment
- Parental Stress Scale
- Short Mood and Feelings Questionnaire
- Life Events Questionnaire
- For the Spanish version, please email us using the “Contact Us” tab below.
Our service fees are fixed; however, we offer a sliding scale of fees that can lower the amount you pay. Based on household size, income, and unusual circumstances, you may be eligible for a fee discount.
You can oshcc-sliding-fee-application.pdf if you want to request the sliding scale. Please let us know of any significant changes in your financial status. You may request a review at any time should you require a fee adjustment. Note: “Therapy packages” are not eligible under the Sliding Fee Schedule. EAP clients do not pay for services if your EAP provider approves your active units.
Good Faith Estimate:
Following acceptance of services, we will discuss fees and the cost of care with you, including providing you with an estimate of the cost of services. All clients are entitled to a Good Faith Estimate that will be given in writing upon request.