Intake Form

Please download and print out the documents.  Fill all pages completely and bring them with you to your INTAKE appointment along with all the requested and required documents.  This document may be filled out electronically or by hand (black ink).

We request payment in advance of the first appointment. For your ease and convenience we accept payment on-line through Paypal.  You may submit payment in the mail with checks or money orders as well.  Payment needs to be received prior to the appointment being scheduled.  Thank you.

Please call or email if you have questions. We can be reached at 469-399-1134 or info@c1cgroup.org.