Contact us - We'll reply promptly
Your information:
* Indicates required field
*Your First NameYour First Name
*Your Last NameYour Last Name
Your Addresssomething more
0 /
Your Citycity
Your Statestate
*Your PhonePhone
Your Cell/Other Phonecell/other phone
Potential Client information:
*First NameFirst Name
*Last Namelast name
Date of Birthdate of birth
Select each issue that is applicable below:
SymptomsSymptoms 4
SymptomsSymptoms 3
SymptomsSymptoms 2
SymptomsSymptoms 1
Tell us any specific info about client we should know...Specific info about client we should knowTell us any specific info on client we should know...
0 /
Admissions: Phone (800) 474-4848 x1 Fax (909) 793-4499 admissions@benchmarkyas.com Billing: billing@benchmarkyas.com
Use your Insurance. Apply!