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
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