Request for Integrative Services
Integrative Services are offered to those impacted by by the Route 91 incident on 10-1-17.
To request authorization to participate, please complete the following:
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Name(s): *
Best way to contact: *
Please provide email address, phone number, or other contact info.
Service(s) requested: *
†must be used in conjunction with (or as a follow-up to) other evidence-based treatment
Required
Description of goal or purpose of service(s): *
Please check all that apply: (optional)
If a therapist or someone else recommended you, please let us know who: (optional)
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