On the form below, you will need to submit all documents related to your discipline, and complete a self-audit checklist (which you can complete here).
We will draft a service agreement specific to your disciplinary situation. The service agreement will be due within 10 days of receipt and must be returned before a meeting will be scheduled. You will be contacted by email to complete the intake process and schedule your assessment.
If you have any trouble completing or submitting this form online, please contact Rachel at email@example.com or (857) 383-3250. We aim to respond within 48 hours of receipt of forms. Please whitelist firstname.lastname@example.org and monitor spam filters to ensure that you receive our response.