(1) submit your answers online -OR-
(2) print form and scan, email, or mail in completed form

This form should be completed prior to your initial consultation.

Select link that best describes you to complete and submit online 


Select link below (if you prefer) to print form and fill it in


Once you complete the printed form, (1) send via email, (2) scan and upload below, or (3) mail it in.

mailing address:

145 S Livernois Road #285

Rochester Hills Michigan 48307

email address:

scan  & upload:

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