Low-Cost Fee Discount Program Application

Imtasik Family Counseling Services offers our client forms online so they can be completed in the convenience of your own home or office.

  • Download the application below and fill in the required information. 

  • Please bring application and required documents with you to your appointment or scan and email to dp.imtasik@gmail.com.

6809 Indiana Ave Ste 210 Riverside, CA 92506: Phone 951-289-9335