• Therapist's Information

    Below you will need to upload a copy of your Bachelor’s Degree or Master’s Degree Diploma and a signed and dated copy of your accumulated hours!
  • Clinic Information

  • (First date treating patients)
    Date Format: MM slash DD slash YYYY
  • Criminal Conviction/Termination Disclosures

    The following questions are required by Forward Health/Medicaid to complete the enrollment process. You are the "applicant".
  • Drop files here or