DUI Program – 72-hour Reschedule Request


You may submit this form to request a reschedule. This form must be submitted at least 72 hours prior to your scheduled activity. The fee for a reschedule is $10.00.

Submission of this form does not automatically result in approval of your request. We will email or call you to confirm the reschedule.

Section 1: Client Information
Section 2: Program Location
Section 3: Credit Card and Payment Information