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Personal Intake Informatiion
Sending Authority; Are currently under the supervision of any of the following?
Marital  Status
Military History
Work History
Drivers Licence
Physical and Mental Health
Do you now or have you ever had any of the following: Please select all that apply
Abuse History
Legal History

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Contact Us
Men's Facility
Phone 918-770-3647
Fax 479-752-3411

Women's Facility
Phone 9184539919
Fax 9184581065

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