전환 센터 예약 입금 양식 우리의 위치 마리에타 2759 델크 로드 스위트 2425 매리에타, 조지아 30067 (404) 503-8069 로렌스빌 561 W 파이크 스트리트 스위트 206 로렌스빌, 조지아 30046 404-781-7468 덜루스 2702 덜루스 하이웨이 스위트 A 덜루스, 조지아 30096 404-781-7468 Diversion Center Appointment Reservation Deposit Form Registration Information*Please contact your local Diversion Center office and set up an appointment BEFORE making your appointment reservation deposit*Client Name* First Last Phone*Email* Deposit* Price: You will be charged a non refundable $25 to hold your appointment. Date of Appointment MM slash DD slash YYYY Message:Terms & Conditions* By making this deposit, you agree to our refund, attendance, rescheduling, and privacy policies. View Our Policies Please Sign Below:*Payment InformationAddress on Card* Street Address City State / Province / Region ZIP / Postal Code Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name EVALUATIONS Alcohol & DrugAlcohol & Drug/Clinical DUIAnger Management CLASSES Level 1Shoplifting/Theft PreventionAnger ManagementFamily Violence InterventionAlcohol & Drug Awareness Values ClarificationPrime For Life®Moral Reconation TherapyParentingVictim Impact Panel OTHER Individual CounselingDrug TestingResources for CounselorsServices for Inmates TweetSharePin
