Please print and fill out these forms and return them to us with a copy of your insurance card in order to get on the schedule for Psychological Testing.
For Counseling, please fill out these forms and return them before your first scheduled appointment if possible –if not, please come in well before your appointment allowing 30-45 minutes to fill them out in our office. Thank You!
- Adult Medicaid Intake Forms
- Youth Medicaid Intake Forms
- Regular Insurance Intake Forms
- Records Request/Release of Information
Please bring filled out forms with you to your first session.
4737 Afton Pl., Ste A
Chubbuck, ID 83202
10:00 AM to 5:00 PM
Sanctuary: We serve the Chubbuck, Pocatello, and South East Idaho Area.