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Please download the Intake Form by clicking on the link.

Intake Form


  1. Save the form on your computer.
  2. Open up the form on your computer.
  3. Fill out all of the boxes.
  4. Save your completed form on your computer.


  1. Type your first and last names in the boxes below.
  2. Click on the Browse… button and select your saved, completed Intake Form.
  3. Click the blue Send button.

Thank you for your support.