New Client Intake Form

To register for the service, please complete the online new client intake form below. Note that you must complete all fields marked with a red asterisk. Per privacy laws, new client intake forms must be completed by each adult over the age of 18. All minor’s (18 years and younger) intake forms must be completed by a parent or guardian.

IMPORTANT: After completing and submitting your online form, you are still required to call our main office at 901-458-4000 or 800-445-5011 to schedule your initial appointment.

Please make sure you have viewed the CONCERN: EAP Notice of Privacy Rights [PDF, 56 KB].