Depressed? Anxious? Family problems? Need someone to talk to? We'd like to help.

You can take the first step in feeling better by talking to a therapist at Family Counseling Center. If you live in the middle Georgia area and would like to schedule an initial counseling session, you may either complete the form below and submit it online immediately, print and fax it to 478-745-0881, or mail it to us. Someone from our staff will contact you the next business day after receiving your information. You may also call at 478-745-2811 to schedule an appointment.

Note:  Fields marked with an asterisk (*) are required.

Your Full Name*
Home Phone*
Cell Phone
Street Address*
City*
State*
Zip
E-mail*
Date of Birth
Sex: Male   Female   
Ethnicity: African American   Caucasian   Hispanic   
Other   
Spouse's Name
Have you received counseling services from our office before?Yes   No   
If so, when?
Who was your counselor?
Most convenient time for our staff to contact you
What is the issue you are concerned about?
 

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