Client Intake Form
Thank you for your interest in becoming a My Life Unleashed client!

This Application is the first step in our process toward getting to know each other. Once this form is completed, you will receive an Email with more information about next steps - including insight on program time frame, costs, etc.

This form is meant for new client leads. If you are looking to contact us for another reason email us at info@mylifeunleashed.biz; or call us at (719) 626-3090.
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Note: For the purpose of this form, the "Client" is the person in need of a Service Dog.
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