Intake Forms
To begin the intake procedure, simply download the forms below, fill them out and fax or drop them off. See our contact page for fax and office locations.
Intake Forms - > PDF
Confidentiality Policy - > PDF
Intake Procedures
You’ve decided
it’s time to make a change. To access our services you need to
fill out two quick forms. We have provided you with two formats
of the forms on the right and below that you can download,
print and fill out. Then you can drop them off at one of our
offices, fax them, or mail them to us. We can then contact you
to start the process of connecting you with one of our programs.
To find an EKASS office closest to you, or a fax number, click on the Contact
Us icon on this page.
Intake Forms - PDF
Format (0.1 MB)
Confidentiality Policy - PDF
Format (0.1 MB)
Intake Forms - Word
Document (0.2 MB)
Confidentiality Policy - Word
Document (0.2 MB)
