A PDF of your completed form will be sent to the email address you provide below.

Please note that you will need to upload a recent (within the last 7 days) fully dressed picture of yourself from the waist up with no one else in the picture, including pets, for Gary to scan while reviewing your intake form. The image must be in either a JPG, PNG or PDF file format and the file size must be smaller than 8 MB. There will be a place to submit this file on the last page of the form. It might be easiest to have this picture file prepared before beginning to fill out the Client Information Form.