Psychologist Session

INITIAL IOP ADMISSION FORM

Whether you are a provider or a potential client, fill out this initial admissions form to be reviewed for pre-authorization into the program.

Pre authorization for IOP from insurance can take 24-48 at least to determine coverage. This information is critical to determine clients coverage and payment. Clients will be required to sign a payment agreement. 

*Please give us 2 business days to respond to your submission*

Which IOP program are you interested in?
Referral source?
Does the client have suicidal ideations?
Does the client have current homicidal ideations?
FSC IOP would like all future clients to agree and adhere to policies. Which will include no type of weapon or illegal use of substances will be allowed on premises.

Thanks for submitting!