Appointment Request Form
Thank you for contacting us!  Please answer the following questions and we will get back to you shortly.
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Name *
Email *
May we contact you using this email? *
Phone *
May we leave a message at this phone number? *
What service are you inquiring about? *
How did you hear about The Rosetta Center? *
Tell us briefly what you are seeking support for.  Please note: we do not do assessment, take custody cases, active legal cases, or workers compensation cases. *
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