Online Intake Form

Fill out the form below to apply for help with our office.  Please be as complete as possible, and include any important supporting documents.  You may save and continue this form later at any point.

If you need help filling out the form, would like an accommodation, or have questions, then please give us a call!  We’re happy to help!

For a more detailed explanation of our services, please see our intake chart.

If you have any questions, please call our office at 919-856-2195 or email us at