This form is intended to collect essential information to support you throughout your participation in programs offered by Good Men Health. Please complete the form in full, ensuring that no sections are left blank. All information provided will remain confidential and will be used solely to better assist you.

This document outlines important information regarding our services and business policies. Please review it carefully before initialing, signing, and submitting. If you have any questions or require clarification, feel free to contact us via email.

This form is used to determine the most appropriate program placement for potential clients, based on the recommendation of a qualified professional and/or legal entity. Please complete and submit the form, ensuring that the referral source’s contact information is included.