Every client gets a customized level of care to fit their needs.
2150 West Washington St
Allentown, Pennsylvania

Fax: 610.465.9444

Office: Mon - Fri 8:00am - 5:00pm
Closed Saturday & Sunday

Client Application SLIDER copy

New Client Application

Client's Name (required)

Contact Email (required)

Female Male 

Date of Birth


Zip Code

Home Number

Mobile Number

Insurance Provider

Size of Household

Physical Status

Behavioral Status