Anger Management Registration
Thank you for choosing First Choice Counseling Center. To register for our anger management class please fill in the information below. If you do not hear from us within 24 hours of form completion, contact us at 
410 989 9922.
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First and Last Name *
Home Address *
Phone Number *
Email Address *
What date would you like to start (Wednesday)? *
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/
DD
/
YYYY
Reason for Referral/ Reason for request for anger management classes: *
Lawyer Name and Contact Information 
Probation/Parole Officer Name and Contact Information
Identification *
Required
Terms of Service & Payment Agreement

By submitting this form, I authorize First Choice Counseling Center to charge my provided payment method for the full program fee. I understand that:

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