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Thank you for your referral!

Please enter the information below, and we will take care of the client from here.

~ Your partners at The Authenticity Center

Person/Agency Making Referral

Client Information

Enter information on the client you are referring to TAC.

Birthday
Month
Day
Year
Payment Needs

Please click any options that apply for this client. These are our current options.

Request for Contact
Permission to contact client directly
Client will get in touch
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