Application Form

Thanks for your interest. We’re eager to meet you!

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Subject

Introduction / Cover Letter

NOTICE:

As of March 27, 2025, the records of all current and former clients of Family Therapy Center will be transferred to Brightline Medical Associates, P.C.. If you would prefer your records not be transferred, or would like a copy sent elsewhere, please contact us at information@ftcsv.com by May 15, 2025.

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To best fit your schedule, we see clients 7 days a week, including evenings and weekends.
Call us at (408) 389-3538 x1 to learn more about our San Jose-based services.
We see clients both in person and virtually throughout California.
We look forward to hearing from you!