Submit Intake Forms
Your forms will be carefully reviewed by a master level clinician on our Intake Team, and you will be contacted within one business day of submission.
Submitting Intake forms simply allows us to learn about you and your treatment needs, it does not in any way commit you to treatment.
Please fill out forms accurately and in their entirety.
We really appreciate your time completing these forms so that we can find the best level of care and fit of facility for you or your loved one.
Child & Adolescent Preliminary Assessment
Adolescent Program Evaluation
Adult Preliminary Assessment
Adult Program Evaluation
Release of Information
Please submit one form for each healthcare provider. If you are 18 years or older and would like a parent or family member involved in treatment, please submit a release form for that person.
Personal Request for Medical Records
Need a copy of your medical records for personal use? Just let us know and we’ll send you what we have on file.
Let us research your healthcare benefits on your behalf
Healthcare Provider History
A comprehensive history of recent medical and clinical treatment