Appointment

Positive Behavioral Interventions and Supports (PBIS) is an evidence-based, tiered framework for supporting persons’ behavioral, academic, social, emotional, and mental health. When implemented with fidelity, PBIS improves social emotional competence, academic success, and school climate. It also improves health and wellbeing. It is a way to create positive, predictable, equitable and safe learning environments where everyone thrives.

New client referral form

Steps for new participantss:

Referral from parent or agency

Print and complete participant form (ENG)
Spanish coming soon (SPN)

1a. or Referral from school

School-Based Universal Referral Form

Search your school for CTDS#

with counselor or social work information

070199008 Hope College and Career Readiness Academy
078765103 SOUTH POINTE JUNIOR HIGH SCHOOL
078983201 SOUTH POINTE HIGH SCHOOL

Insurance form

Print and Complete Prior Authorization (PA) form to your appointment, with doctor information

Arizona Complete Health Forms

2022 AzCH Outpatient PA Form (PDF)

Banner University Health

Behavioral Health Prior Authorization Form

BCBS/AZ Health Choice Forms

Medical Services and Behavioral Health Prior Authorization Form

Mercy Care

Prior Authorization: Standard Request Form

United Healthcare

UnitedHealthcare Community Plan Prior Authorization Arizona CC form

American Indian Health Plan (AIHP) skip section 2

3. Enrollment forms

Print and complete...

Enrollment packet (ENG)

4. Click here to > Schedule Appointment

5. See ya soon...

Please bring all forms, copy of AHCCCS insurance card with valid ID for all interested members, to your appointment.

Future Options NPI #1720613466

Optional information

We use therapy notes (EHR) electronic health records documentation, admin and online secure storage system.

AHCCCS members, use client's portal to schedule an intake and future services.

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