Keep scrolling within the blue area above until you complete all the questions! There are several sections and you will need to click a "Next" button for each section. You will know you are done when you click the "Submit" button at the end of the form.

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You should see a message that says, "Thank you for submitting your Medical Intake Form! Your information has been received by Lighthouse Complex Care of Delaware. We are happy you found us. You will be contacted to schedule an appointment. Thank you for your patience as we process your information."

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If you need to fill out an additional form for another family member there will be an option to submit another response.

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If you are having trouble completing the form on this page try clicking here to view it in a different window.

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If that still doesn't work please send us an email at inquiry@lhccde.com

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Thank you!