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Intake form

The Journey Center Logo (representing our commitment to mental health and well being.)
In preparation for your first appointment, please complete the following form. The information you provide here is protected by law and held in strict confidence.
May I leave a message
May I e-mail you? (Please note: E-mail correspondence is not considered to be a confidential medium of communication) *
How did you hear about The Journey Center?
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Upload File
Upload supported file (Max 15MB)
Please select your preferred therapist:: Required

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