Appointment Request

New Client Information

Please correct the errors described below.

New Client Information - Appointment Request

We will always be discreet and only leave a message for you to call us back.
If you do not see your insurance company, please select other and please note that Balanced Living does not accept Medicaid or Medicare.
(can be found on the insurance card)
Can typically be found on the back of Insurance Card
    Please upload a file
      Please upload a file

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