Safe & Sound Protocol
Please take a moment to fill out this application for our Safe & Sound Program (SSP). We thank all referrers and applicants for your interest and support of this program.
Please provide at least one phone number. Your mobile number can be used to look up your account and receive text message appointment reminders
Refers to current gender which may be different than what is indicated on your insurance policies
Thank you. Your application will be confidentially reviewed by a committee of Clarity Clinic Team Members
Your information will be encrypted.
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