SPECIAL PROGRAM REGISTRATION
Northland-Rural Therapy Associates

To register, please print this form and use it to register using the
following methods:
  • By Phone
Call with the information on the form.  
Local:  928-779-1679
Toll Free:  866-779-1679

  • By Mail
Mail form
Northland Rural Therapy Associates
125 E. Elm Ave Ste 103
Flagstaff, AZ  86001    

  • By Email
Send information on form to northlandrural@gmail.com