Participant Application If you or someone you know would like to participate in any of our IMURS therapy programs, please fill out the form below and we’ll be in contact with you right away! IMURS Program Participant ApplicationPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.First Name *Last Name *Age *Diagnosis(s) *Program *Mental HealthCognitivePhysical Disability interested best Age Sub-Program *PTSDDepression/AnxietyAutismDown SyndromeParalysisPain ManagementOtherParent/Guardian InformationName *FirstLastContact InformationPhone *Email *What is the best time to call? *MorningsAfternoonsEveningsProgram TimingHow soon would you be interested in beginning? *Submit
