Enrollment: as easy as 1 - 2- 3

1. Ready?

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Want to learn more about enrollment?  Its easy, just complete the interest form below and our intake specialist will do the rest! Enrollment is limited so we highly recommend submitting your interest form today. 

2. Get Set

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Email or fax your interest form to us:


  • Fax: 818-991-7722
  • Email: Admin@qbssocal.com
  • Drop off at nearest branch

Our intake specialist will follow up with you within 24 business hours.  

3. Now Relax

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Your in great hands! Our intake specialists are experts at completing the eligibility process. Some insurance companies may request additional information. Our Intake Specialist will keep you informed each step of the way.

QBS Interest Form

Simply click the "download" button below and complete our interest form. Now your ready to submit. We offer 3 easy options to submit your interest form.  


  • Email to Admin@qbssocal.com
  • Fax:  (818) 991-7722
  • Drop off to your local branch

Potential Client Interest Form (pdf)

Download