Sand Creek

Intake Form to Access Services

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If you are experiencing an emergency, please call 911 or go to the nearest emergency room.

If you have an urgent need, please call Sand Creek directly at 888.243.5744 to speak with a Sand Creek Clinician. In the moment support is available 24/7 by calling 888.243.5744.

If you would like to access EAP services, please fill out the intake form and click on "Submit Form" after the Special Instructions question. An EAP Intake Consultant will respond to your request by calling you at your desired contact number within 1 business day. 

Staff office hours are Monday-Friday 8:00 am to 4:30 pm CT.

If you do not hear from a Sand Creek Intake Consultant within 1 business day, we did not receive your online submission form. Please give us a call to speak directly with us.

All information is kept confidential from your employer, unless you give explicit, written consent to share your information.

* Indicates Required Fields

Employee/Member's Information
Employee/Member's First Name
Employee/Member's Last Name
Requester's Information
First NameIf you are not the employee
Last NameIf you are not the employee
Date of Birth
AddressAddress 1
Address 2
Zip Code
Contact Phone Number
Special Instructions
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I agree that I am submitting this form for myself or a minor for whom I am legal guardian.