Thank you for taking the time to complete this intake form. The details of this form are confidential and will be kept in a secure location (please see confidentiality policy).

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Please note: Policy changes effective October 1, 2017 regarding missed appointments – First missed appointment (late notice or no notice) will not be charged, but after a second missed appointment, therapy will be put on hold until worker addresses with the referred client(s). The second missed session will be billed.