Request for Services
Please complete the requested information for services at Strong Foundations Psychological Associates, Inc.  Once your completed entry is received, you will receive an email back from support@sfpgh.com with additional details.  Please enter N/A for any request for information that does not apply. Thank you!
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Email *
Patient Full Name *
Patient Email Address (N/A if the same as above). *
Patient Telephone Number *
Patient Age *
Type of Service Requested *
Parent Information
If you are a parent and requesting services for your child, please provide YOUR information below:
Parent Full Name
Parent Email Address  (N/A if the same as above)
Parent Telephone Number
Have you reviewed our Billing & Policy for Therapy and Testing Services on our website?  PLEASE NOTE THAT THIS FORM IS JUST A REQUEST FOR SERVICES.  ONCE SUBMITTED, A LINK WILL BE SENT TO YOU TO COMPLETE A SECOND FORM TO BE ADDED TO THE ACTUAL WAITING LIST FOR SERVICES. *
Would you like to be added to our mailing list for updates on services, groups offered, therapist updates, etc.?  We do not and will not share or sell your email address with or to anyone.   If you opt in now, you will always have the option to OPT out or be removed from the mailing list in the future.  *
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