Art Therapy House Inc. - Client Intake Survey
  • This form is for potential clients seeking art therapy and other wellness related services at Art Therapy House Inc. Please fill out this form completely and as accurately as possible. Completion of this form indicates your desire to be placed into our referral list and in no way starts or guarantees a therapeutic relationship.
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Email *
First Name:
Last Name: *
Mailing Address (Street, City, State, Zip Code) *
Phone Number (XXX) XXX - XXXX *
Are you filling out the Client Intake request for yourself or for someone else? *
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