Telehealth Forms
March 17, 2020 | Leave a Comment
Please download & print these forms.
Credit Card Authorization Form
Professional Services Agreement
Footsteps Counseling Telemedicine Informed Consent Form
You can submit these forms by:
- Fax: 804-715-3233
- Email: info@footstepscounseling.com (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.