Register for Therapy in MICHIGAN
**Please note, we are ONLY accepting clients in OAKLAND COUNTY, MICHIGAN at this time.
Please enter your first and last names. *
Please enter your email address. *
Please enter your phone number. *
Please enter potential client's first and last names. *
Please select potential client's date of birth. *
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Please enter potential client's health Insurance (Just list insurance company please) *
Please enter potential client's city and state of residence. *
**Please note, we are ONLY accepting new clients in OAKLAND COUNTY, MICHIGAN at this time.
Where are you looking for therapy to be conducted? *
Is there anything else you think is important for us to know?
Who should we thank for referring you to us? *
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This form was created inside of The Behavior Guru PLLC.