Intake Form

Once your pre-intake form is filled out, it will be sent to our intake coordinators and you will be contacted within 24 hours. If you are out- out-state or incarcerated, you can use the printed application on the bottom of the page and email,fax, or mail.

Email: intakecorp1@gmail.com

Fax: (480)-269-9426

Address: P.O. Box 1586

Mesa, Arizona 85211

Print Intake Application