CONFIDENTIAL INTAKE FORM
Please click the button below to download the confidential intake form in pdf format. Your counselor will review this form and the information to become more familiar with your case. Please complete the form and return it to us. You may complete the form electronically using Word or you may print the document, complete and scan the document by taking a picture using your smart phone and returning the completed document (image) to us by email at firstname.lastname@example.org. Thank you!
Click here to download the Confidential Intake Form