Forms

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NON-PROFIT FORMS

Class Scholarship Application

Please return completed application to:

dferguson@themaplecenter.org or  kcunningham@themaplecenter.org

or Mail to: 

The Maple Center Nonprofit                                                                                                     1801 N 6th St, Suite 600                                                                                                       Terre Haute, IN 47804                                            

CLINICAL FORMS

Please return forms either by email, fax at 812-232-8059 or US Postal Service to 1801 N 6th St, Ste 600, Terre Haute, IN 47804

Dr. Kristen Walton's Forms

    Female Intake Form

    Male Intake Form

    7 day diet Form

 
To contact us:
 
1801 North 6th Street
Suite 600
Terre Haute, IN 47804
 
Clinical Office: 812-235-4867
Nonprofit Office: 812-234-8733
Fax: 812-232-8059
E-mail: info@themaplecenter.org
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