Send us your testimonial

 +
Is this a revocation? *
 +
I authorize Family Care Center or it's affiliate companies (Direct Care, Ketamine Colorado Springs, Solon Behavioral Health) to: *
I prefer that only the below description is used. *
By checking below, I authorize the above selected option for use on social media and give my consent freely as a public service without expecting payment. *
I understand that I may revoke my consent in writing at any time and that the used of my photo, video, and / or statement authorized by this release will immediately cease. *
clear
I hereby revoke this Authorization to Disclose information. *
clear