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Sign up for
NAFFA Wellness

The NAFFA Wellness Intensive Virtual Program

offers 3 hours classes (morning or evening) 

available Tuesday, Wednesday, Thursday

NAFFA Wellness puts the security of the client at a high priority. Therefore, we have put efforts into ensuring that the information you send is safe and only seen by authorized staff, if you have any questions, please do not hesitate to reach out to NAFFA Wellness staff.

NAFFA WELLNESS REGISTRATION

Referring Agency Information
Client Demographics
Emergency Contact
Legal
Probation / Parole Officer / Case Worker / Court Contact
Presenting Problem:
Symptoms
Safety Elements
Suicide Attempt
Physical Aggressions
Suicidal Ideations
Sexual Perpetration
Self - Harm
Other

Thanks for submitting!

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