Forms
Before your first appointment, please complete the appropriate intake packet found below. Please print and complete the forms, and bring them to your first appointment. Please contact our office at 928-774-6364 if you have any questions. Instructions are included. You will need the Adobe Acrobat Viewer to view and print these files.
Adult Intake Packet (.doc) - For adults who will be using insurance coverage or paying out of pocket.
Adult EAP Intake Packet (.doc) - For adults who will be using EAP benefits provided by the City of Flagstaff, Coconino County, the Flagstaff Housing Authority, Highlands Fire Department, Summit Fire Department, or WL Gore and Associates
Child Intake Packet (.doc) - For children who will be using insurance coverage or paying out of pocket.
Child EAP Intake Packet (.doc) - For children who will be using EAP benefits provided by the City of Flagstaff, Coconino County, the Flagstaff Housing Authority, Highlands Fire Department, Summit Fire Department, or WL Gore and Associates.
EAP Mandatory Referral Info Form (.doc)