A Center for Marriage and Family Counseling
 P.O. Box 9728 Fayetteville, NC 28311
Call
1 (910) 294-8084
Phone Lines Open 24/7
Patient Forms for New and Existing Clients
If you are a new patient to A Center for Marriage and Family Counseling there are several documents that need to be filled out before our first meeting.  Please sign and date the below documents for the clinician that you are seeing.  E-mail, fax or mail a copy of your insurance card (front and back) to:

E-mail: cmfcdocs@gmail.com
Fax: Attn David Richards 336-875-8816
Mail: James M. Barry MSW, LCSW or Laura M. Barry MSW, LCSW
         P.O Box 9728
         Fayetteville, NC 28311
Please be advised that every patient, regardless of insurance type, needs to fill out the consent to release information form. It needs to be filled out with your insurance companies information, and then signed and dated. This is needed to begin sessions. Thank you.

When filling out the forms the ID number on your insurance card is used (typically located on the front of the card.)

Tri Care Instructions:
Client Name is the spouse or dependent (unless retired).  The Sponsor is the active duty or retired service member.  The Sponsor ID number is the Service member's SSN not the DOD number. Social Security numbers (SSN's) are not printed on DoD identification cards. The current ID card contains the following identifiers:
 1) DoD ID number- a 10 digit number that is NOT used for TRICARE claims, eligibility, or authorization and referral purposes.
 2) DoD Benefits Number (DBN)- an 11-digit number that relates to TRICARE benefit eligibility. This number is located on the back of the card. 

Appointments will NOT be confirmed until ALL documents are signed and returned.

For any questions, please contact: (910) 294-8084







New Patients
Teletherapy
For Teletherapy, we are using Google Meet, which is a HIPPA compliant, telemedicine platform that allows us to do remote sessions.  There is no need to download an app, you can simply access our sessions through your internet browser on your computer, iPad or iPhone.  A link will be sent to you via e-mail prior to our scheduled appointment.  The link will will prompt you to enter your name and then you will gain access to the waiting room.  When your clinician is ready, you will be let into your session.
Please be advised if you have filled out the intake forms from above then you have already completed this document and you do not need to fill it out again. 

For all existing clients:
Please download, sign and date the Consent for Teletherapy form for the clinician you are seeing.  E-mail, fax, or mail your signed document to:

E-mail: cmfcdocs@gmail.com
Fax: Attn David Richards 336-875-8816
Mail: James M. Barry MSW, LCSW or Laura M. Barry MSW, LCSW
         P.O Box 9728
         Fayetteville, NC 28311