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INTAKE FORMS

Please select the intake form from the options below based on the program you have registered for

QUITTING SMOKING 

If you are interested in the quitting smoking program, please click below to be taken to the intake form:

STRESS MANAGEMENT

If you are interested in the Stress Management program, please click below to be taken to the intake form:

BAD HABITS & PHOBIAS

If you are interested in breaking free of bad habits and phobias, please click the link below to be taken to the intake form:

HEALTHY EATING & WEIGHT LOSS

If you are interested in the Healthy Eating & Weight Loss program, please click below to be taken to the intake form:

PAIN MANAGEMENT 

if you are interested in the pain management program, please click below to be taken to the intake form: