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Agency Referral Forms

Adult Referral

Adolescent Referral

 
Release of Information

Consent To Treatment

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Scan QR Code For LEWC Inc PRP Referral Form

Wellness Workshop Registration Form

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Scan QR Code For LEWC Inc. Adolescent Referral Form

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Scan QR Code For LEWC Inc Adult Referral Form
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PRP Referral Form 

 Text or Call and speak with an intake specialist for referrals and program services today!

(800) 867-2395 or (410)200-9016

​© 2017

Life's Energy Wellness Center Inc.

  For more information: Call or Text (410) 200-9016            (800) 867-2395 Press 1 to speak with a support specialist

​  Fax: (410)443-0842

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Mailing Address: P.O. Box 123

Easton, MD 21601

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Life's Energy Wellness Center Inc,  is a equal opportunity employer and does not discriminate against any applicant or employee because of race, color, religion, spirituality, sex,  gender identity, national origin, disability, age, or military or veteran status in accordance with federal law. In addition, complies with applicable state and local laws governing nondiscrimination in employment in every jurisdiction in which it maintains facilities.  Providing reasonable accommodation to qualified individuals with disabilities in accordance with applicable laws.

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https://www.fns.usda.gov/civil-rights/usda-nondiscrimination-statement-other-fns-programs

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Life's Energy Wellness Center Inc is a 501(c)3 Certified Chartiable Orgnization

All Donations and Bequest are 100% Tax Deductable

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https://www.fns.usda.gov/civil-rights/nds

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