Client Intake Form

Please fill out the form below. If you have more than 5 minutes, fill out the more detailed Client Intake Form - go here.

 

Please bring the following with you to your appointment; without this documentation your counseling session will not be as successful as possible.

 

  • Proof of income and Social Security number(s)

  • Any documentation related to the financial situation that you are coming to discuss, which may include the most recent statements from creditors, credit card account statements, collection notices, student loan statements, tax notices and overdue bills.

 

Any questions? Contact Barbara at (717) 358-9364.

BFEC Client Intake Form
Reasons For Seeking Counseling

Thank you for filling out the intake form.

The Ann B. Barshinger Financial Empowerment Center for Lancaster County