Supervisor Request / Waive Fees / Other
We would love to hear your thoughts, suggestions, concerns or problems with anything so we can improve!
Request Type
No Show / Last Min Cancellation Fee Waive
Supervisor
Client Complaint to Counselor
Questions
Full Patient Name
*
First Name
Last Name
What's the date of appointment for which you need an exception made?
-
Month
-
Day
Year
Name of counselor (if applicable)
Please describe the situation:
*
Agent Name
please ignore if you are not an employee of our company
Your Email
*
example@example.com
Please submit any documentation showing the situation described by you above
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