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Residents of Pennsylvania and Virginia: To get started with services for your child or yourself, please fill out the below HIPAA-compliant form, and we will get back to you as soon as possible—typically within 24 hours. If you are under the age of 13, a parent or legal guardian must complete the form on your behalf.
Please note: This form requires insurance information. If you do not intend to use insurance and would like to pay out of pocket, please mark N/A in the required fields.
