Online Intake Form (Downloadable file & payment on the bottom of the page)
Payment Options: (Payment Options)
Download Form: (Click Here)
Please print out our intake form, fill it out completely, and fax or e-mail it to us at:
Fax: (866)539.5505
Email: rootedintake@gmail.com
Fax: (866)539.5505
Email: rootedintake@gmail.com