<p align="justify">You can submit the Online Intake Form or, if you prefer to manually complete the Intake Form, please use the Word version of the Intake Form. The following forms may be emailed, faxed, or mailed, along with the necessary medical and pharmacy records.

<a class="form-a" href="http://manleyandassociates.velinajewelry.com/wp-content/uploads/2017/01/SSA-release.pdf">SSA Release</a><a class="form-a" href="http://manleyandassociates.velinajewelry.com/wp-content/uploads/2017/01/Consent-to-Release.doc">Consent to Release</a><a class="form-a" href="#">Proof of Representation Agreement</a>