Keep scrolling within the blue area above until you complete all the questions! There are several sections and you will need to click a "Next" button for each section. You will know you are done when you click the "Submit" button at the end of the form.

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You should see a message that says, "Your intake form responses have been successfully submitted!"

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If you need to fill out an additional form for another family member there will be an option to submit another response.

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If you are having trouble completing the form on this page try clicking here to view it in a different window.

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If that still doesn't work please send us an email at info@lighthousecomplexcare.com

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Thank you!