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. 

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.
 

Office: 435-799-5035

Fax: 435-535-3782

115 Golf Course Road Suite E Logan,UT 84321

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©2020 by Family Solutions Counseling.