Act For MS - Activities

73-710 Fred Waring Dr.
Suite #118
Palm Desert, CA 92260

Apply for Assistance

Become a Member

Tele: 760.773.9806
Fax: 760.406.6137

actforms@verizon.net

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Coachella Valley Community Resources

Please download/print these application forms, fill them out and mail them to our office. After our office receives and reviews your application you will be notified if we can assist      you with our many programs.

                 - Application for Assistance

                         - Liability Release

                 - Neurologist Release

                 - Neurologist Verification

                 - Client Program Questionnaire

© Copyright 2009 ACT for MS. All rights reserved