New Clients – Children’s Behavioral Health & Children’s RSafe

Please complete the form below to make a Children’s Behavioral Health or Children’s RSafe appointment.

Open Form

If you have any trouble accessing the form call 1-833-903-2376.

Please Note: To protect client information confidentiality, the Intake Form may timeout if left idle for too long.  It is recommended that you review the form in advance, or print and prepare prior to beginning to enter your personal information.  It will be easier if you have all of the required information you need to complete the process before starting.  If you need to leave it before it has been completed, and it does time out, any information previous input will not be saved and you may have to begin again.  We are here to help you.  If you have any difficulties or concerns, please contact us at 1-833-903-2736.