Telehealth Forms

March 17, 2020 | Leave a Comment

Please download & print these forms.

Credit Card Authorization Form

counseling information

Professional Services Agreement

Footsteps Counseling Telemedicine Informed Consent Form

You can submit these forms by:

  • Fax: 804-715-3233
  • Email: (DO NOT EMAIL credit card number – you will need to call the office with this information)
  • Mail: 6851 Courthouse Road, Suite 300, Chesterfield, VA 23832.