Intake and Referral Form

Fill out and submit prior to your first appointment. 

 

Informed Consent

Review.   We can provide you copies at your first appointment. 

Financial Agreement

Review.  Copies can be provided for you at your first appointment. 

Please review.  Copies will be provided at your first appointment

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107 S. First St. Coldwater, OH 45828  

Ph: 419-953-8252

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