A gambling addiction can take it's toll in anyone's life. If you or someone you know has a gambling addiction, please take our confidential survey.
If you'd like to know more please call 1-877-574-1254
Our Consumer Portal lets you fill out registrations, request appointments and prescription renewals -plus pay your bill online. Click here to access the portal.

Please call the appointment number at the top, right of this page before accessing the forms below.
Intake Letter
Adult Information Sheet
Child-Adolescent Information
Client Medical Worksheet
Privacy Practices
Grievance Statement
Do you want to learn how work will affect your Social Security Benefits?
If you are interested in learning about the Ticket to Work Program or other Work Incentives, you can attend a FREE Work
Incentive Seminar Event (WISE). WISE are community events held by local organizations for beneficiaries to learn more
about available work incentives through accessible, informal, learning opportunities.
877-743-8237 (V/TTY)
Space is limited so sign up today!
Please sign up at least five days in advance if you need assistive aids or services.
To schedule an appointment call:
1-877-574-1254
BILLING INQUIRIES:
1-877-641-8348
SAMHSA
NAMI Indiana
MHA of Indiana
Crisis Intervention Team