Intake Form

Please download and print out the documents.  Fill all pages completely and bring them with you to your INTAKE appointment along with all the requested and required documents.  This document may be filled out on the computer or hand written.

 

We request payment in advance of the first appointment. For your ease and convenience we accept payment on-line through Paypal.  You may submit payment in the mail with checks or money orders as well.  Payment needs to be received prior to the appointment being scheduled.  Thank you.

 

Please call or email if you have questions.  Joan@c1cgroup.org

Emails will be responded to much more quickly than voice mails.  Emails are required for arranging visits and scheduling exchanges.  This is for your protection and for the sake of clarity.