Operation Fulton County OFC Rehab and Beyond - Inquiry Form
Free Therapy Inquiry form for Stroke, Brain Injury Survivors, and others with disabilities - Fulton County Residents
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OFC
FREE THERAPY PROGRAM FOR STROKE, BRAIN INJURY, AND OTHER DISABILITIES
Rehab and Beyond offers free therapy that is available immediately for Stroke, Brain Injury Survivors, and other disabilities residing in Fulton County.  Fill out this inquiry form and submit to see if you qualify.  Once your information is received, we will contact you.  This opportunity is limited , so complete as soon as possible.  
Full Name *
Are you between the ages of 18 and 64 years old? *
Required
Age *
Date of Birth

*
Are you a Fulton County resident? *
Required
Address *
Email *
Phone number *
Are you a Stroke, Brain injury survivor, or person with other disabilities? *
Are you able to receive outpatient therapy? *
What will be your form of transportation to your therapy appointment(s)? Personal, Public, etc. *
How did you hear about our program? (Name of referral, social media platform, Google, etc.) *
Submit
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