GMC Referral Form

FamilyWorks Clinic a therapy clinic operated by Valdosta State University's Marriage and Family Therapy Graduate program. GMC has a partnership with FamilyWorks to provide counseling services to faculty, staff and students. Graduate interns are available by appointment for confidential personal counseling or group counseling sessions. All interns are under the direct supervision of experienced, state licensed, and qualified faculty of the program. Please complete this form to be referred for an appointment.

Information in this referral form will only be shared with the staff at FamilyWorks

Please fill out the fields below.

Red asterisks indicate fields that are required for submission. Write N/A if unknown

Information about person being referred