An accessible version of this form that works with screen readers is available here.

Notice of Reasonable Accommodation:  The above intake form is not usable by screen readers often used by visually impaired persons, but there is an accessible version of the form that can be used by screen readers here. This issue is due to third party vendor software issues that are not within our control to change. We are working to create a solution. In the meantime, if you are visually impaired or you use a screen reader, please identify yourself as such by emailing or calling 510-832-5001. We will prioritize your intake information first. If you are not visually impaired or do not use a screen reader, we ask that you please reserve this direct contact option for visually impaired persons using screen readers. We respond to all contacts within two business days.