Please complete this form if your child is an existing ChanceLight® client or you have already completed a New Client Intake Form and would like to communicate with us about your child’s needs, including:

• Status of intake
• Waitlist status
• Scheduling
• Billing
• Your child’s therapy team

We will respond to you within two business days to discuss your needs.

The information you provide to ChanceLight® is private and secure, and ChanceLight® will never share your personal information with third parties.