Rosalino Counseling Services
Safe and healthy environment

Forms

Welcome to Rosalino Counseling Services. We look forward to providing you with excellent and efficient counseling services. If you are new to RCS Counseling, please take a few minutes to fill out the form below. The information will help us to better understand your situation as well as potential solutions in helping you get your life back on track. Please note, this information is confidential, for our use only, and will not be released to anyone without your written permission.
En Español
Additional Forms

GENERAL INTAKE FORM



Cancellation Policy
Consent to Bill Medical Insurance
Consent to Treat Minors
Credit Card Authorization
Intake Form
Patient Health Questionnaire
Release Form
Rosalino Counseling Services • 383 W. Fountain Street • Providence, RI 02903 •  Suites 106 and 108
Phone (401) 400-1863 Fax (401) 270-5322

Copyright ©2020 Rosalino Counseling Services All Rights Reserved
Providence, Rhode Island