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Emergency Wellness Program
Middle East Conflict Mental Wellness Emergency Program
At the Boris L. Henson Foundation, we are committed to promoting mental health and well-being, recognizing the profound impact that current world events can have on our collective mental health. In light of recent unsettling news and the potential toll it may take on individuals' mental health, BLHF developed an emergency fund to provide free mental health care for individuals affected by this trauma. We understand that staying informed about global events can sometimes lead to feelings of fear, anxiety, and a sense of loss of control. Additionally, the exposure to traumatic news may evoke distressing memories for those who have experienced similar events in the past. The BLHF Free Mental Wellness Support Program was developed to cover the cost of five virtual or teletherapy sessions by licensed clinicians in our network.
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Connecticut
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Florida
Georgia
Hawaii
Idaho
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Kansas
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State
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Please Choose a Provider in YOUR STATE
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Alabama: Alicia Bennett, CTRS
Alabama: Devin Williams | Resilient Therapy and Solutions
Alabama: Dr. Brittany Peters | Center for Wellness & Clinical Development
Alabama: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Alabama: Krishula Edwards, ALC|Edwards Essentials, LLC
Alabama: Memendra ( Mendy) Harris, LPC -Summerlane Counseling LLC
Alabama: MLC Consulting, LLC
Alabama: Monique Pierre-Louis, LPC|En Touch Counseling & Consulting, LLC
Alabama: New Beginnings Counseling, Fightress Aaron
Alabama: Pieces of Me Behavioral Health, LLC
Alabama: S.M.A.R.T. Girl, Incorporated
Alabama: Twanna Carter, LPC | JBC Counseling & Consulting, LLC
Alaska: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Alaska: Pieces of Me Behavioral Health, LLC
Arizona: Covington-McGee Christian Counseling
Arizona: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Arizona: Erica Tatum-Sheade, LCSW
Arizona: Pieces of Me Behavioral Health, LLC
Arkansas: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Arkansas: LaBrenda Thomas, LCSW, LSSW
Arkansas: Pieces of Me Behavioral Health, LLC
California: Amber Boyd, LMFT | Healing Through Authenticity
California: Angela L. Mull Psychotherapy Creating Beautiful Minds
California: Astute Mind Therapy & Wellness with Whitney Lawrence-Redden, LCSW
California: Covington-McGee Christian Counseling
California: Deitra Baker, LMFT
California: Delena Zimmerman Therapy
California: Dr. Crystal Harper Rosebud LCPC, CTSS
California: Dr. LaWanda Hill, LLC
California: Dr. Renee Manneh, LCSW, DHSc|Renewed Strength Counseling Services
California: Dr. Sarah Williams, LMHT, LPC
California: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
California: Eboni S. Williams, MA, LPCC
California: Edify Counseling Group LLC
California: Francine Leonard| The Black Lotus Wellness Clinic
California: Jerisha LaCrae Rutlin, M.Ed, LPC, LPCC, NCC|Therapy for Black Women
California: Jamie Kirk/ JK Family Therapy, Inc
California: Kimani Norrington-Sands, Ph.D., Lifting As We Climb Consulting
California: Michelle Bee, LMFT
California: Nia J. Henderson MA, LMFT
California: Niesha Davis, MSW, LCSW, CAMS-II, CCTP
California: Pamela Moore-Jones, LCSW
California: Pieces of Me Behavioral Health, LLC
California: Tamika Carter, LADC-MH | Advantage Public Institute
California: Tamika J. Carter, LADC, LAADC
California: The WHOLE-Self Healing Institute, Inc.
Colorado: Dr. Brittany Peters | Center for Wellness & Clinical Development
Colorado: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Colorado: Pieces of Me Behavioral Health, LLC
Connecticut: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Connecticut: Kevin Muhammad, LCSW
Connecticut: Pieces of Me Behavioral Health, LLC
Delaware: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Delaware: Pieces of Me Behavioral Health, LLC
Delaware: Sankofa Healing Studio
Delaware: The WHOLE-Self Healing Institute, Inc.
District of Columbia: Dr. Lisa Pittman, Ph.D.|LePiatz Psychology, LLC
District of Columbia: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
District of Columbia: The MECCA Group, LLC
District of Columbia: Montrella Cowan, MSW, LICSW | Affinity Health Affairs, LLC
District of Columbia: Petrina L. Williams LICSW, LCSW-C | Miracles In Motion Therapy and Consulting LLC
District of Columbia: Pieces of Me Behavioral Health, LLC
District of Columbia: Razaria Best, LMFT|Knowledge Therapy For Thoughts, LLC
District of Columbia: Transcend Clinical Services, Inc
District of Columbia: Victoria Griffin, LPC | Resiliency Counseling, LLC
Florida: Ascent Psychotherapy Center
Florida: Chiron Counseling LLC
Florida: Circle of Wellness Enterprises LLC
Florida: Dr. Brittany Peters | Center for Wellness & Clinical Development
Florida: Dr. Cortnie S. Baity, LMFT | Onward and Upward Psychotherapy & Consulting Services, LLC
Florida: Dr. Crystal Harper Rosebud LCPC, CTSS
Florida: Dr. Mia R. Wilson, LPC|Sankofa Behavioral Health Services
Florida: Dr. Renee Manneh, LCSW, DHSc|Renewed Strength Counseling Services
Florida: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Florida: Edify Counseling Group LLC
Florida: Emerge Counseling Services
Florida: Isaac Collins, LMSW|Collins & Collins Counseling Services
Florida: Janel Holland, LCSW |Power for Living Enterprises, LLC
Florida: Just Be Therapeutic Services, Sheniqua Dones-Wallace LMHC, NCC
Florida: Krista Woods, M.S.W., LCSW
Florida: Kristian A. Holmes, LMHC-QS, CST, NCC, Ed.S
Florida: Lakisha Foxworth, LMFT
Florida: LaMora Pace, LCSW, CAP / The Healing Crest® Counseling Services, LLC
Florida: Lathosha Alexander, MSW, LCSW, CPC|Healthy Minds Healthy Hearts Therapeutic Services, LLC
Florida: Melissa Comeau, Ed.S., LMHC, LMFT, NCC, /Relationship Expert, Heartfelt Counseling Center, LLC
Florida: Mellisa Gooden, LMFT, LMHC, MA | A Good Place For Help
Florida: Monique Pierre-Louis, LPC|En Touch Counseling & Consulting, LLC
Florida: Patrice Brantley, LMHC|Seed Sowing Sistah Movement, LLC
Florida: Pieces of Me Behavioral Health, LLC
Florida: Sankofa Healing Studio
Florida: Shameka Collins, LMSW | Collins & Collins Counseling Services
Georgia: Child Loss Center Inc. | Dr. Yolanda Fountain Hardy
Georgia: Chiron Counseling LLC
Georgia: Dr. Cortnie S. Baity, LMFT | Onward and Upward Psychotherapy & Consulting Services, LLC
Georgia: Dr. Mia R. Wilson, LPC|Sankofa Behavioral Health Services
Georgia: Dr. Sarah Williams, LMHT, LPC
Georgia: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Georgia: Edify Counseling Group LLC
Georgia: Glenda Demas LPC, ACTP | Pearls of Change Wellness
Georgia: Janel Holland, LCSW |Power for Living Enterprises, LLC
Georgia: LaPrincess Foster, LPC|Kesi Therapy and Holistic Arts
Georgia: Lathosha Alexander, MSW, LCSW, CPC|Healthy Minds Healthy Hearts Therapeutic Services, LLC
Georgia: MLC Consulting, LLC
Georgia: Pieces of Me Behavioral Health, LLC
Georgia: Victoria Griffin, LPC | Resiliency Counseling, LLC
Hawaii: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Hawaii: Pieces of Me Behavioral Health, LLC
Idaho: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Idaho: Pieces of Me Behavioral Health, LLC
Illinois: Cynthia Chambers MA, LCPC, CGP, CCTP | Safe Space Mental Health LLC
Illinois: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Illinois: Krista Woods, M.S.W., LCSW
Illinois: Pieces of Me Behavioral Health, LLC
Illinois: Tiffany Rowland, LCSW - Right Choice Therapy, LLC
Indiana: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Indiana: Krista Woods, M.S.W., LCSW
Indiana: Pieces of Me Behavioral Health, LLC
Iowa: Pieces of Me Behavioral Health, LLC
Kansas: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Kansas: Pieces of Me Behavioral Health, LLC
Kentucky: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Kentucky: Pieces of Me Behavioral Health, LLC
Louisiana: Calvary De'Rosa Counseling and Consulting
Louisiana: Cherlyn Cyres, LCSW|Paradise Therapeutic Services
Louisiana: Devin Williams | Resilient Therapy and Solutions
Louisiana: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Louisiana: Glenda Demas LPC, ACTP | Pearls of Change Wellness
Louisiana: Ledora Yerks, M.Ed., LPC, NCC|Motivate Wellness Behavioral & Relationship Health Services, LLC
Louisiana: Pieces of Me Behavioral Health, LLC
Louisiana: Rashan Carter, LCSW|Passion & Purpose Fulfilled
Louisiana: Shawnnell Batiste, LPC|Choosing Empowerment
Maine: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Maine: Pieces of Me Behavioral Health, LLC
Maryland: CapitolHill Consortium for Counseling & Consultation LLC
Maryland: Dr. Amanda Davis-Buie, PhD, LPC, LBS, NCC|Strength, Love, and Motivation, LLC
Maryland: Dr. Leeshe Grimes, LCPC|Elevated Minds
Maryland: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Maryland: Isaac Collins, LMSW|Collins & Collins Counseling Services
Maryland: Petrina L. Williams LICSW, LCSW-C | Miracles In Motion Therapy and Consulting LLC
Maryland: Pieces of Me Behavioral Health, LLC
Maryland: Razaria Best, LMFT|Knowledge Therapy For Thoughts, LLC
Maryland: The MECCA Group, LLC
Maryland: Transcend Clinical Services, Inc
Maryland: Twanna Carter, LPC | JBC Counseling & Consulting, LLC
Massachusetts: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Massachusetts: Isaac Collins, LMSW|Collins & Collins Counseling Services
Massachusetts: Keyona Aviles, LMHC|Inspired Release
Massachusetts: Pieces of Me Behavioral Health, LLC
Massachusetts: Shameka Collins, LMSW | Collins & Collins Counseling Services
Michigan: Alcia Freeman, PhD, LPC, NCC | Legacy Living Services LLC., Online Counseling for Emotional & Mental Health
Michigan: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Michigan: Emerge Counseling Services
Michigan: Leticia Berg, M.A., LLP | Berg Psychotherapy
Michigan: Pieces of Me Behavioral Health, LLC
Michigan: Tamara White MA, LPC, CRC|OCVR-Care LLC
Minnesota: Denise Williams, LMFT | Life Curation PLLC
Minnesota: Devin Williams | Resilient Therapy and Solutions
Minnesota: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Minnesota: Pieces of Me Behavioral Health, LLC
Mississippi: Devin Williams | Resilient Therapy and Solutions
Mississippi: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Mississippi: Nadia L. Gaynor, LPC | New Life Goals Counseling and Consulting
Mississippi: Pieces of Me Behavioral Health, LLC
Mississippi: Victoria Griffin, LPC | Resiliency Counseling, LLC
Missouri: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Missouri: Janee V. Henderson, M.Ed., LPC
Missouri: Jerisha LaCrae Rutlin, M.Ed, LPC, LPCC, NCC|Therapy for Black Women
Missouri: Pieces of Me Behavioral Health, LLC
Missouri: Renee Hodgins, M.Ed., LPC | Counseling & Educational Center, LLC
Montana: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Montana: Pieces of Me Behavioral Health, LLC
Nebraska: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Nebraska: Pieces of Me Behavioral Health, LLC
Nevada: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Nevada: Jennifer McClendon, LPC| Renew Counseling, Consulting, and Wellness Services
Nevada: Pamela Moore-Jones, LCSW
Nevada: Pieces of Me Behavioral Health, LLC
Nevada: Razaria Best, LMFT|Knowledge Therapy For Thoughts, LLC
New Hampshire: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
New Hampshire: Pieces of Me Behavioral Health, LLC
New Jersey: Adiasha Richards-Thornhill, LMHC, LPC|Growth and Transitions Counseling
New Jersey: Chanel McCord, MA, LPC, ACS
New Jersey: Dr. Amanda Davis-Buie, PhD, LPC, LBS, NCC|Strength, Love, and Motivation, LLC
New Jersey: Dr. Renee Manneh, LCSW, DHSc|Renewed Strength Counseling Services
New Jersey: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
New Jersey: Janee V. Henderson, M.Ed., LPC
New Jersey: Jennifer McClendon, LPC| Renew Counseling, Consulting, and Wellness Services
New Jersey: Pieces of Me Behavioral Health, LLC
New Jersey: Sankofa Healing Studio
New Jersey: The WHOLE-Self Healing Institute, Inc.
New Jersey: Twanna Carter, LPC | JBC Counseling & Consulting, LLC
New Mexico: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
New Mexico: Pieces of Me Behavioral Health, LLC
New York: Adiasha Richards-Thornhill, LMHC, LPC|Growth and Transitions Counseling
New York: CHAT & Change Counseling Services
New York: Cheryl Mchunguzi ,LMSW RMT|Metamorphosis, LMSW P.C.
New York: Dr. Alicia Delgado-Gavin, Psy.D | Tears Behind the Smile, LLC
New York: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
New York: Edify Counseling Group LLC
New York: Momentum Testing Record
New York: Isaac Collins, LMSW|Collins & Collins Counseling Services
New York: Kamilah Matthew, LCSW | Deeply Rooted Therapeutic Services PLLC
New York: Keisha Cox, LCSW
New York: Kellee Barrett, LCSW | KB's Lighthouse Counseling Services
New York: Pieces of Me Behavioral Health, LLC
New York: Rachel Johnson, Half Hood Half Holistic LLC
New York: Shameka Collins, LMSW | Collins & Collins Counseling Services
North Carolina: Adrienne Charleston of Butterfly Flow Counseling, PLLC
North Carolina: Candice Coulter, LCMHC|A Child’s Perspective Child and Adolescent Counseling Services
North Carolina: Dr. Renee Manneh, LCSW, DHSc|Renewed Strength Counseling Services
North Carolina: Dr. Sarah Williams, LMHT, LPC
North Carolina: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
North Carolina: Dr. Sherille D. Barber, PhD, M.Ed., LPCS | Barbertherapy & Associates
North Carolina: Jason Peace, LCSW|Renewed Strength Counseling Services
North Carolina: Jewrine Brown, LCMHC, NPP, CTMH, THTC, CCATP
North Carolina: Niki Evans-Hook, LCMHCA|Renewed Strength Counseling Services
North Carolina: Pieces of Me Behavioral Health, LLC
North Carolina: Razaria Best, LMFT|Knowledge Therapy For Thoughts, LLC
North Carolina: Scenic City Therapy, LLC. | Dr. Lar'Mara Henderson, LCSW
North Carolina: Sonyia Richardson, Ph.D., M.S.W., L.C.S.W. | Another Level Counseling and Consultation
North Dakota: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
North Dakota: Pieces of Me Behavioral Health, LLC
Ohio: Brittany Woodley, LCSW|The Empowering Space
Ohio: Dr. Amanda Davis-Buie, PhD, LPC, LBS, NCC|Strength, Love, and Motivation, LLC
Ohio: Dr. Sandra Miller-Jones, PhD, LPC, NCC | Owner of SunWalk Counseling Services, LLC
Ohio: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Ohio: Emerge Counseling Services
Ohio: Pieces of Me Behavioral Health, LLC
Oklahoma: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Oklahoma: Pieces of Me Behavioral Health, LLC
Oklahoma: Tamika Carter, LADC-MH | Advantage Public Institute
Oklahoma: Tamika J. Carter, LADC, LAADC
Oregon: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Oregon: Pieces of Me Behavioral Health, LLC
Pennsylvania: Alphonso Nathan, LPC|Brightside Counseling
Pennsylvania: Dr. Amanda Davis-Buie, PhD, LPC, LBS, NCC|Strength, Love, and Motivation, LLC
Pennsylvania: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Pennsylvania: Jennifer McClendon, LPC| Renew Counseling, Consulting, and Wellness Services
Pennsylvania: Pieces of Me Behavioral Health, LLC
Pennsylvania: Sankofa Healing Studio
Pennsylvania: Shaakira Gillette, LCSW | Synchronicity, LLC / Be Well
Pennsylvania: The WHOLE-Self Healing Institute, Inc.
Rhode Island: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Rhode Island: Pieces of Me Behavioral Health, LLC
South Carolina: Dr. Sarah Williams, LMHT, LPC
South Carolina: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
South Carolina: Dr. Sherille D. Barber, PhD, M.Ed., LPCS | Barbertherapy & Associates
South Carolina: Pieces of Me Behavioral Health, LLC
South Dakota: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
South Dakota: Pieces of Me Behavioral Health, LLC
Tennessee: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Tennessee: LaBrenda Thomas, LCSW, LSSW
Tennessee: MLC Consulting, LLC
Tennessee: Pieces of Me Behavioral Health, LLC
Tennessee: Scenic City Therapy, LLC. | Dr. Lar'Mara Henderson, LCSW
Texas: Abe Turner, MA, LPC-A | The Weekend Therapist
Texas: Amber Boyd, LMFT | Healing Through Authenticity
Texas: Angela L. Mull Psychotherapy Creating Beautiful Minds
Texas: Ascent Psychotherapy Center
Texas: Brittany Woodley, LCSW|The Empowering Space
Texas: Calvary De'Rosa Counseling and Consulting
Texas: Cherlyn Cyres, LCSW|Paradise Therapeutic Services
Texas: Chikeitha Owens M.A LPC | Abundance of Hope Counseling Service
Texas: Covington-McGee Christian Counseling
Texas: Deitra Baker, LMFT
Texas: Demetryas Pennegraph, MS-Mental Health Counseling- R.E.A.L. Wellness (Restoring, Educating And Leading)
Texas: Dr. LaWanda Hill, LLC
Texas: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Texas: Edify Counseling Group LLC
Texas: Glenda Demas LPC, ACTP | Pearls of Change Wellness
Texas: Isaac Collins, LMSW|Collins & Collins Counseling Services
Texas: Janee V. Henderson, M.Ed., LPC
Texas: Kimberly Ann Parker, Revive to Thrive Wellness, PLLC
Texas: Krista Woods, M.S.W., LCSW
Texas: Mindful Wellness Reset: Relax, Release & Renew, PLLC
Texas: Omolola Taiwo, NCC, LPC
Texas: Pieces of Me Behavioral Health, LLC
Texas: Rashan Carter, LCSW|Passion & Purpose Fulfilled
Texas: Shades of Resilience Counseling
Texas: Shameka Collins, LMSW | Collins & Collins Counseling Services
Texas: Shawnnell Batiste, LPC|Choosing Empowerment
Texas: The Inner Mind Counseling & Wellness
Utah: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Utah: Pieces of Me Behavioral Health, LLC
Vermont: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Vermont: Pieces of Me Behavioral Health, LLC
Vermont: Sankofa Healing Studio
Vermont: Twanna Carter, LPC | JBC Counseling & Consulting, LLC
Virginia: CapitolHill Consortium for Counseling & Consultation LLC
Virginia: Dr. Lisa Pittman, Ph.D.|LePiatz Psychology, LLC
Virginia: Dr. Sarah Williams, LMHT, LPC
Virginia: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Virginia: Dyverynce Vaughan, LPC|Feeling Moody LLC
Virginia: Focused Behavioral Interventions, LLC
Virginia: Pieces of Me Behavioral Health, LLC
Virginia: Shaena Wiggins, LCSW | Transformative Therapeutic Services, LLC
Virginia: The MECCA Group, LLC
Virginia: Twanna Carter, LPC | JBC Counseling & Consulting, LLC
Washington: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
Washington: Nia J. Henderson MA, LMFT
Washington: Pieces of Me Behavioral Health, LLC
West Virginia: Dr. Seleena Smith|REAL Liberation Coaching & Consultation Services
West Virginia: Pieces of Me Behavioral Health, LLC
Wisconsin: Pieces of Me Behavioral Health, LLC
Wyoming: Pieces of Me Behavioral Health, LLC
What is your current employment status?
*
Unemployed
Student (High School/College)
Employed - Part Time
Employed - Full Time
Retired
Other
Prefer Not to Answer
Do you have internet access and a private space for the virtual sessions?
*
Yes
No
Currently, do you have medical insurance?
*
Yes
No
Have you ever received Mental Health services?
*
Yes
No
When were you last seen?
*
< Less than 30 days
Between 30 days and 6 months
Between 6 months and 1 year
1 year and 5 years
> Greater than 5 years
Please select your primary concern.
*
Feeling of hopelessness
Feeling a loss of community
Feelings of anger, frustration and/or resentment
Lack of supplies or resources i.e food or housing
Change in self-care activities while at home
Employment and financial instability
Increase in alcohol intake/substances
Feeling of loneliness or isolation
Feeling silenced or injustice (marginalized or suffering in silence)
How did you learn about us?
Informed Consent and Participation Agreement - ALL acknowledgments MUST BE CHECKED to process your registration
*
I acknowledge by submitting a Mental Wellness Support Program registration, I authorize sharing my registration and its contents (referral) with my chosen provider and/or company. Questions regarding your HIPAA patient rights, responsibilities and/or release of information must be sent to your treating provider, if desired.
I acknowledge and give permission for any and all information associated with my registration to be used by the Boris L Henson Foundation strictly for billing, statistics and quality assurance.
I acknowledge that service fees for special exceptions, insurance copays, no-shows, and referrals to alternate providers agreed upon between me and my provider are NOT covered by the campaign.
I will ensure the mandated Quality of Service Survey is submitted online after EVERY visit.
All boxes must be checked to process your registration.
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