• R.E.A.C.H. Contact Form

    Thank you for choosing REACH for Tomorrow. This confidential screening will help our Intake Team better understand your needs and determine the appropriate next steps for services. What to Expect: Takes approximately 5–7 minutes to complete Your information is securely transmitted An Intake Coordinator will contact you within 48 business hours. Important: Completing this screening does not guarantee admission into the program. Admission is based on eligibility, clinical appropriateness, program availability, and completion of the intake review process.
  • Today's Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Client Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • What type of service are you requesting?*
  • If you are requesting Substance Abuse Recovery Counseling, which options best describe your need?*

  • Additional Screening Required: Admission to REACH for Tomorrow's IOP/Supportive Housing program requires completion of the IOP Screening Application. Our Intake Team will provide the appropriate screening information.

  • Which County are you requesting services?*
  • Are you currently having thoughts of hurting yourself?*

  • Immediate Safety Information
    If you are experiencing a mental health crisis, call or text 988 to reach the Suicide & Crisis Lifeline. If you are in immediate danger or believe you may act on thoughts of suicide or self-harm, call 911 or go to the nearest emergency department.

    This form is not monitored continuously and should not be used for emergency assistance.

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