Online Client Intake Form
Below is a multi-step online form. There are 12 different sections and you must complete each section before moving on to the next. Make sure to complete the form, sign it, and submit it all in one sitting.
Printable PDF Client Intake Packet
Uncomfortable completing this packet online? You may use our downloadable PDF packet instead. Go to our Packet Download page and select the correct form for your insurance company. Print, and fax your completed packet to 724-532-0701, along with required documentation. Completed materials may also be mailed to us.