Intake Form

IF YOUR INQUIRY IS AN EMERGENCY PLEASE CALL 911, THE CRISIS LINE AT 1-888-353-2273, OR YOUR DOCTOR.

We provide services to children, youth, adults, and families dealing with their own or someone else's substance use concerns.

To book an appointment, we require all new and returning clients (after three months) to complete a Client Intake Form.

CLICK ON THE LINK BELOW TO COMPLETE OUR ONLINE INTAKE FORM

Secure Online EKASS Client Intake Form

When you have completed the Online EKASS Client Intake Form and you've pressed the SUBMIT button at the bottom of the page, our office will automatically receive your form and contact you within 2 business days to book an appointment.

CLICK ON THE LINK BELOW TO DOWNLOAD AND PRINT OUR EKASS CLIENT INTAKE FORM:

http://ekass.com/storage/literature/EKASS Client Intake and letter Revised Apr 2022.pdf

Other options are, to request a fax or email copy of the form be sent to you to be completed and returned to one of our offices. In all options, once we receive your completed Client Intake Form, an EKASS staff member from an office closest to you will contact you within 2-3 business days to book an appointment.

Following the current COVID-19 safety protocols, we offer counseling sessions in-person (with a mask), by phone, or virtual.

Should you have any questions please click on the CONTACT US located top right corner to call one of our offices near you.

This page is encrypted using SSL. Any information you enter is secure and accessed only by our EKASS staff. We will not share this information with any unauthorized parties.