We are pleased that you have chosen to begin this journey with us. This form outlines the arrangements with the third-party organization that referred you to our services. If you have any questions or need assistance at any time, please don’t hesitate to reach out. We’re here to support you every step of the way.
Please note the following:
- A signature is required in one section of this form, which can be completed easily on any mobile device, tablet, or computer.
- The form does not save progress, so it must be completed in one sitting. It will take approximately 3 minutes to complete.
- Click Submit when you are done.
If you experience any issues or have questions about this form, please contact our office.