Forms

Please print forms and complete and bring to first meeting

Adult Intake

        Form

Child Intake

       Form

Release of Information

Insurance Form

Hula Hoop

Form

         Please Click on the Form to open and print your forms.

FEES

Sliding Scale Based on income for Private Pay Clients

 

Intake Fee $100.00

$60,000 and Below       $70.00

$61,000 - $70,000         $80.00

$71,000 - $90,000         $90.00

  $91,000 and above       $100.00

 

Our Fees are based on each client's annual income

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