Request Counseling Services

To request a counseling appointment at Family Service Agency, please fill out this form or call us at (831) 423-9444. We respond to inquiries during office hours, Monday through Friday. Any request submitted outside of business hours will be processed the next business day.

If you are in crisis and need immediate assistance, please call or text 988.

Request an Appointment for Counseling Services

Your Name

First Name

Last Name

Name of client (if different from self)

First Name

Last Name

Client's Date of Birth

Phone Number

Confirm Email

Contact Preferences

Email me

Call me

Location of Services

Select where you would like to be seen for your sessions.

In-Person or Telehealth?

In-Person Only

Telehealth Only

Either In-Person or Telehealth

Insurance

We accept Medicare and MediCal. Clients with private insurance or no insurance will pay for their sessions with our affordable sliding scale fee, based on monthly income.

Have you previously received counseling at Family Service Agency?

Yes

Type of service

Brief description of your issue:

Mornings (8:00AM - 11:00AM) you are available:

Early afternoons (12:00PM - 2:00PM) you are available:

Late afternoons (3:00PM - 5:00PM) you are available:

Evenings (5:00PM - 7:00PM) you are available:

Is there anything else you'd like us to know?

If you are human, leave this field blank.