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New Client Service Request
Complete and submit this form. Once received someone from The Best Option, LLC will contact you during our regular business hours.
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Email
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Your email
Full Name:
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Your answer
Telephone Number with Area Code:
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Your answer
Email address:
*
Your answer
Referral Source:
*
Probation
Parole
Court Ordered
Self Referral
Other
Required
Services Offered:
*
BIPP - 20 Week Virtual Group Class ($30 Enrollment Fee/$25 per session/1 session per week)
Anger Management 4 Hour Block Class ($100 Total)
Anger Management 8 Hour Block Class ($150 Total)
Substance Abuse Assessment ($100)
Substance Abuse Individual Counseling ($50 per session)
Substance Abuse Group Sessions ($30 per group session)
Required
Question(s):
Your answer
A copy of your responses will be emailed to the address you provided.
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