1 Client
2 Evaluation
3 Prelim. Rec.
4 Provider
5 Review

Client Information

* For decertification enter current (T)RBHA
If you are unsure about this information, click Here to find out more

Having trouble submitting packets via this portal? Please call 480-486-5365. If you are still experiencing issues, you may submit via fax at 844-611-4752 or email to EligibilityDetermination.HelpDesk@crisisnetwork.org. However, please ensure you have all the required forms listed above under 'Complete Application'.