Application – Licensed In-Take Assessor – State of FL LMHC, LMFT, or LCSW – Contract

Name*
First Last
Email*
Phone*
Resume Upload*
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Describe Your Qualifications As They Relate To This Position*
Do you have prior experience completing Medicaid or commercial Outpatient Intakes?*
Do you hold an LMHC, LCSW or LMFT License in the State of Florida?*
Have you completed the following level of education: Masters?*
Are you in Lakeland, Florida?*
Where Did You Hear About Us?*
*If School/Other, Please Specify:

Address:	Families First of Florida, LLC
	4902 Eisenhower Blvd, Suite 315
	Tampa, Florida 33634

Phone:	813-290-8560 - please follow prompt when calling
Click Here To See Locations for our Outpatient Services addresses