All new patients must complete the following forms before any treatment or assessment is performed at Faulkner University Center for Therapy and Research. All new patient forms can be filled out in the Patient Portal or clients can print out the forms below and bring them into the clinic.
If you’re seeking mental health counseling services, please fill out the appropriate form below.
The pediatric form should be completed for anyone age 0 to 18.
The adult form should be completed by anyone age 19 and older.
If you are seeking speech and language services, please fill out the appropriate form below.
The pediatric form should be completed for anyone age 0 to 18.
The adult form should be completed by anyone age 19 and older.
If you are seeking occupational therapy services, please fill out the appropriate form below.
The pediatric form should be completed for anyone age 0 to 18.
The adult form should be completed by anyone age 19 and older.
Phone: 334-386-7351
Fax: 334-386-7354
Email: clinic@faulkner.edu
Address: 5445 Atlanta Hwy. Montgomery, AL 36109
Consistent client attendance is of the utmost importance to achieve the best outcomes and continue our clinic operations. Because of this, a strict attendance policy is in place.
