Client Information Form [] 1 Step 1 Client Information Form Name(first and last name) Address Phone Number Today's Datedate_range Are you a Midland County Resident?YesNo Do you struggle with Substance Use Disorder?YesNo Commentsmore details0 / Submit Form Office Use Only Registration Start Date Completion Date Commentsmore details0 / keyboard_arrow_leftPrevious Nextkeyboard_arrow_right FormCraft - WordPress form builder Client Agreement Form [] 1 Step 1 Client Agreement Form This Funding provides for a limited period of three months (90 days) each service year.For A Brighter Tomorrow will cover half of the total cost of services. The client is responsible for the remaining balance.It is required that you maintain a negative drug and alcohol test. If a test is positive, you will be notified and funding services may be discounted.Please be aware that a missed test, can also lead to the loss of funding services.We've found that clients who check in with us every 30 days get the most out of our services. A quick call or email is a great way to keep communication open and ask any questions that you may have. Nameyour full name Datedate_range Submit Form keyboard_arrow_leftPrevious Nextkeyboard_arrow_right FormCraft - WordPress form builder
