Family Counseling Associates Marriage and Relationship Counseling, Individual and Family Therapy

  • Family Counseling Associates
  • Marriage and Relationship Counseling
  • Individual and Family Therapy
  • Frequently Asked Questions
  • Dr. Brian S. Canfield
  • Irene LeBlanc Canfield, M.A.
  • Affiliated Counselors and Therapists
  • Office location and directions
  • Fees and Insurance Policy
  • Contact Us
  • Confidentiality and Privacy Policy
  • Appointment Request
  • Clients Intake Forms
  • Links & Resources
  • Hot Topics!
  • Arkansas affiliate practice
ONE STEP CLOSER To a Brighter Tomorrow
Dr.  Brian S. Canfield
318-608-4318
drbsc@aol.com

Irene LeBlanc Canfield, M.A.
318-504-4177
lpc8955@aol.com





Client Intake Forms

If you are a new client, please complete the following forms and bring them to your first session.

  • Counseling Intake Form - New Client
  • Limits of Confidentiality/Therapy Cancellation Policy

If you would like for us to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of information with your provider:

  • Authorization to Disclose Information Form

Counseling Intake Form - New Client  
Limits of Confidentiality/Therapy Cancellation Policy  
Authorization to Disclose Information Form  

Note: To download Adobe Acrobat Reader for free, click here.

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