Family Centered Therapy & Provider Supports
785.691.5653
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IMPORTANT FORMS

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PHONE: 785-691-5653
EMAIL: tonidetherage@gmail.com

Referral Forms

For your convenience we have our referral form online. 
This gets us the information a lot faster and saves you time! 
Fill OUt Online!
If you're having trouble completing the referral form online, you may download a PDF version of the form. Then, email it to tonidetherage@gmail.com or mail it to FCTPS, 720 E. 9th Street, Unit 8, Office #3, Lawrence, Kansas, 66044


referral_form.pdf
File Size: 85 kb
File Type: pdf
Download File

Authorization to Release Information

To get a release form, just click on the button below to download the authorization to release information form. Then, email it to tonidetherage@gmail.com or mail it to FCTPS, 720 E. 9th Street, Unit 8, Office #3, Lawrence, Kansas, 66044


Download Release Form
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