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Confidential Intake Form

Your information is strictly confidential and there are no costs for our services!

The first step in the intake process involves you filling out this confidential intake form. Required fields are marked with an asterisk. Please fill out all other fields as you are comfortable.

The next step will be scheduling a 30-minute, confidential, intake interview. Someone from our staff will be in touch with you within two business days to arrange scheduling.

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What is your relationship with the person who needs our services?

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