_____   FamilyLight  Fact Sheet completed

 _____   Consulting fee paid by credit card, wire transfer, or personal check

 _____   Copies of clinical and academic records.  Please do not send originals..

 _____   A short biography of the young person's life, written by the parents (Please include significant events from infancy to the present as well as your impressions about the current problems.)

 _____   Put releases in place with doctors, therapists, schools, and programs so that Tom or an associate may speak with them regarding your son or daughter

 ____   Airfare, if applicable: When travel expenses involve airfare, the airfare and a possible booking fee must be paid by credit card several days prior to the home visit.  Contact us for instructions on faxing a Credit Card Authorization form to us.  Other expenses, such as hotel and car rental, will be billed after the home visit.

            Note:  (1) "Change fees" are likely to be applied when a purchased ticket is changed; these fees are the responsibility of the client  if the client has initiated the change.   (2) We regret that we cannot use frequent-flier tickets, complimentary tickets, or tickets purchased from Internet web sites.

To have the above information arrive on time, you may fax it to 775-890-0597

Send it Overnight  (if necessary) for weekday arrival to -           

                        Thomas J. Croke and Associates, Inc

                                    645 E. Pittsburgh Street, #334

                                    Greensburg, PA 15601

Call if you need weekend delivery information.

Please call us with any questions.