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Notice: This form is not for transmitting personal health information. Please do not include details about your medical history or condition. For confidential matters, contact us by phone.

It is the policy of this facility to strictly prohibit any form of discrimination against clients or employees on the basis of race, sex, religion, national origin, color, age, disability, health status, military status, pregnancy and any other status protected by federal or state law. There is no distinction in eligibility for, or in the manner of providing, any client service provided by the facility. All services are available without discrimination and rules of courtesy are uniformly applied to all. Discrimination is prohibited in the terms and conditions of employment and in the conduct, actions, communications and behavior of our employees.