2017 Fall Services
Registration is REQUIRED for ALL CLIENTS. Registration is DUE: Monday, July 10, 2017. If you register past this date, we cannot guarantee that you will get the exact schedule that you would like. Fall Schedules will begin Monday, August 14th through the entire school year.

Please complete this form in it's entirety. The information you provide is vital to accurate scheduling. Please contact your clinic Office Manager if you have any questions. Thank you!

Email address
Client Name
Your answer
Birth Date
MM
/
DD
/
YYYY
Parent Name
Your answer
Phone Number
Your answer
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