IOP Inquiry Form

Intensive Outpatient Treatment Program with Creative Counseling and Studio

Please correct the errors described below.

Requested participation in IOP is not a guarantee for services. Intake for IOP is based on clinical compatibility, financing and the availability within the program. We will work diligently to help meet your treatment needs. If we are not the best fit, we will provide you with quality referrals.

Our team will reach out to gather more information in order to confirm your intake appointment for IOP. If the appointment is confirmed, we will send you a secure link inviting you to create an account to complete your intake forms and schedule. We look forward to working with you.

Be thorough. Provide details about location, dates, treatment providers etc.

HIPAA Notice of Privacy

This form is hosted on Hushmail Forms. Hushmail is an encrypted HIPAA complaint platform that is used for internal purposes only with Creative Counseling and Studio. To learn more about Hushmail's HIPAA and encryption standards click here. This document will be securely stored within your electronic health record.

Your information will be encrypted.