These forms are all in PDF format. They require Adobe Reader (free) to be installed in order to read them. Click this link to get Adobe Reader.

Information Form
Fee Agreement (Adult)
Fee Agreement (Child)
Understanding and Consent to Treatment
Reduced Fee Request - Mentorship - The One Cause

What to do:

  1. Click on each the above links, as appropriate.
  2. Download or print the form.
  3. Fill the forms out. Each client needs to fill out and return an Information Form, a Fee Agreement, and a Consent Form.
  4. Mail the forms to: Kiera Donna Laike, IRW, 27650 Franklin Road, Southfield, Michigan 48034
  5. If you know how, you could fill out the forms, scan them, and send them via email to If you choose this option, please send them in a standard format, like JPG or PDF.