• Screening Packet

  • Main Office:

    3080 W. Washington St., Suite B. P.O. Box 976, Stephenville, TX 76401

  • Offices Located In:

     Cleburne, Decatur, Granbury, Stephenville, Mineral Wells

  • Contact Numbers:

    Toll Free: (800) 375-1395, Fax (254) 965-7416

  • Client Profile Information

    Please carefully answer the following questions and provide the required documentation.
  •  -  -
    Pick a Date
  •  /  /
    Pick a Date

  • Case Management Form

  • Please answer the following questions to help your counselor provide beneficial referrals at your intake.

    Section A:

  • Section B: If no dependent children, skip to "Section C"

  • They are receiving counseling services from

  • Section C:

    In effort to provide continuity of care and to not provide unnecessary referrals to you, please provide the following information. 

  • Please note, this does not authorize us to contact these providers or release information to them. If you would like for us to contact them, please let your counselor know and a consent can be completed.

  • Screening Instrument for Infectious Diseases

    Field Version

  • Individual is to answer the follow questions truthfully and honestly. Answers will not affect your treatment with STAR Council.

  • Do you live with someone who has any of the following symptoms?

  •  
  • Should be Empty:
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