Anger Management Registration
Course Dates: Saturday, March 6, 2021 10:00 AM
Event Address: 13110 Shaker Heights, Ohio Suite C 200 Cleveland, Ohio 44120
Contact us at (216) 512-0321 or

Please note upon registration you will be entered into our system and sent an email with access to your client portal, and email confirmations of your anger-management classes. If you do not have insurance, you will be considered self-pay and will be sent a credit card form via your client portal. It is important to sign any consent or intake forms via your client portal. It is all electronic. You do not need to print anything or bring in any documentation.
Email *
Full Name *
Email *
Phone # *
Date of Birth
Do you have insurance?
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Insurance Provider
Insurance Member ID #
Are you available every Saturday for 10 weeks *
I understand that I will have to pay $50 per session ($500 in full) or provide accepted insurance. *
I understand that I must attend All Sessions in order to receive a certificate of completion. *
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This form was created inside of The Black Mental Health Corporation.