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Client Intake Form

Please fill out the following form to help us understand your mental health needs so that we can match you with one of our mental health professionals.

Will you be paying for services out of pocket or using insurance?

Thanks for submitting! A representative from our office will contact you within 24 hours.

Experience Exceptional Family Care

Give Us a Call Today
(863) 946-0284
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Address

43 Avenue J SW

Moore Haven, FL, 33471

Contact

Office: 863-946-0284
Fax: 863-946-0794

Hours of Operation

Monday                     8am - 6pm

Tuesday-Thursday    8am - 5pm
Friday                        8am - 4pm
Saturday/ Sunday     Closed

© 2023  Johnson Riverside Family Practice, LLC. All rights reserved.

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