We are happy that you have chosen us as your Behavioral Health Provider, and we look forward to working with you!

We understand that times have changed, and therefore the way we normally conduct intakes, assessments, and other services are not always going to be the same right now.

For that reason, if you have any questions at all while you are completing these forms, please feel free to reach out to ANY of the following individuals, regardless of which site you are seeking services from while completing paperwork:

  • Assessment Specialist – Mesa: 480-550-4048 ext. 4104
  • Assessment Specialist – NHW: 602-279-5351 ext. 3536
  • Assessment Specialist – Central: 602-279-5262 ext. 3208
  • Assessment Specialist – Central: 602-279-5262 ext. 3217
  • Behavioral Health Coordinator – Central: 602-279-5262 ext. 3203 and ext. 3214
  • Behavioral Health Coordinator – Mesa: 480-550-4048 ext. 4110
  • Behavioral Health Coordinator – NHW: 602-279-5351 ext. 3515

To make sure that your intake process goes smoothly, please take a moment to review this checklist, prior to submitting your forms:

-Did you PRINT, INITIAL, and/or SIGN your name on all the paperwork in this packet where you see the word “patient” “client” “consumer” or “guardian/ legal representative”?

-Did you DATE all the paperwork in this packet?

-Did you place your INITIALS on any form that requires a preference, acknowledgment, or selection from you (i.e. on the top three spaces of the Advance Directive form)?

-Did you provide us with a copy of your ID, Tribal ID, court and/or legal documentation or guardianship paperwork, and your insurance card (as applicable)? 

Please let us know if you would like to request copies of any of these forms.

What happens next?

After you have submitted your forms, you will be contacted by a NATIVE HEALTH staff member to schedule your intake assessment appointment, which will last approximately 1-2 hours.

Thank you so much!

-The Behavioral Health Department Team

Please Complete All of the Forms Below:

Review and Optional Signature: