Family and Child Treatment of Southern Nevada

Family and Child Treatment of Southern NevadaFamily and Child Treatment of Southern NevadaFamily and Child Treatment of Southern Nevada

(702) 258-5855

  • Home
  • About Us
    • History
    • Team Members
    • Board Members
    • Fundraise with FACT
    • Supporters
  • Trauma Focused Therapy
    • Child Sexual Abuse Victim
    • Adolescent Victims
    • Adult Survivor of CSA
    • Domestic Violence Victims
    • Sexual Assault Survivors
    • Sex Trafficking/ CSEC
    • Resources
  • Other Programs
    • Donna's House
    • Internship Program
    • Juvenile Self-Management
    • Youth Anger Management
    • Youth Petty Larceny
    • JSB Program
    • ASO Program
    • Community Education
  • Contact Us
  • Merchandise
  • Forms/Payments
  • More
    • Home
    • About Us
      • History
      • Team Members
      • Board Members
      • Fundraise with FACT
      • Supporters
    • Trauma Focused Therapy
      • Child Sexual Abuse Victim
      • Adolescent Victims
      • Adult Survivor of CSA
      • Domestic Violence Victims
      • Sexual Assault Survivors
      • Sex Trafficking/ CSEC
      • Resources
    • Other Programs
      • Donna's House
      • Internship Program
      • Juvenile Self-Management
      • Youth Anger Management
      • Youth Petty Larceny
      • JSB Program
      • ASO Program
      • Community Education
    • Contact Us
    • Merchandise
    • Forms/Payments

(702) 258-5855

Family and Child Treatment of Southern Nevada

Family and Child Treatment of Southern NevadaFamily and Child Treatment of Southern NevadaFamily and Child Treatment of Southern Nevada
  • Home
  • About Us
    • History
    • Team Members
    • Board Members
    • Fundraise with FACT
    • Supporters
  • Trauma Focused Therapy
    • Child Sexual Abuse Victim
    • Adolescent Victims
    • Adult Survivor of CSA
    • Domestic Violence Victims
    • Sexual Assault Survivors
    • Sex Trafficking/ CSEC
    • Resources
  • Other Programs
    • Donna's House
    • Internship Program
    • Juvenile Self-Management
    • Youth Anger Management
    • Youth Petty Larceny
    • JSB Program
    • ASO Program
    • Community Education
  • Contact Us
  • Merchandise
  • Forms/Payments

client Intake Forms:

Client Forms

*All forms MUST be filled out AFTER making an appointment or scheduling group, whether in person or online. Please call the office at (702)-258-5855 to make an appointment.  (Please send new client referrals to lsuyat@factsnv.org) 


Fill-out the appropriate forms prior to the appointment. Click on the intake form link and download the form to your device. Open the downloaded form and enter your information. When finished, save the completed form again to ensure your data is kept. 


You can submit your form back to us by one of the following methods:
1) Attach the saved document to your e-mail, In subject write Attn: Last Name, Appointment Date/Time and send to Intakes@factsnv.org

OR
2) Print and mail to: Family and Child Treatment of Southern Nevada

 8080 W. Sahara Avenue Suite D. Las Vegas NV, 89117

OR
3) Print the completed forms and submit them to the front office on the day of your first visit, at least 15 minutes prior to your appointment. 


If you do not have access to a printer, we are happy to provide the forms prior to your appointment at the clinic.

Free Adobe Downloads

We created our forms with Adobe Acrobat. Below are free Adobe downloads to help access these documents.  

Adobe Acrobat Reader Computer 

Adobe Acrobat Reader Iphone  

Adobe Acrobat Reader Android   

Youth Group Forms

(Anger Management, Youth Violence and Petty Larceny)

Youth Intake Form Referred by Harbor (pdf)Download
Spanish Youth Intake Form Referred by Harbor (pdf)Download
Youth Intake Form Referred by Probation (pdf)Download
Spanish Youth Intake Form Referred by Probation (pdf)Download

Individual therapy forms

Individual Therapy Intake Form (pdf)Download
Spanish Individual Therapy Intake Forms (pdf)Download

jso forms

JSO Intake Forms (pdf)Download
Spanish JSO Intake Forms (pdf)Download

aso forms

ASO Intake Forms (pdf)Download
Spanish ASO Intake Forms (pdf)Download

NOP Forms

NOP Intake Forms (pdf)Download
Spanish NOP Intake Forms (pdf)Download

Group Payments or Donations

Prior to paying for any groups, please confirm fee total with the clinic.  Contact 702-258-5855. Thank you.

Pay with PayPal or a debit/credit card

Connect With Us


Copyright © 2023 Family and Child Treatment of Southern Nevada - All Rights Reserved.

Powered by GoDaddy Website Builder

  • Merchandise
  • Forms/Payments