adult probation referral form
I hereby give consent for release of any pertinent information for your treatment enrollment/progress to Arizona Consulting & Counseling Services (ACCS) to and from Maricopa county Adult Probation Department. By signing, I agree that each of the above agencies can exchange information related to my treatment that is deemed necessary.
Arizona Consulting and counseling services
8263 West Thunderbird Road, Suite 100, Peoria, Arizona 85381
submit
ACCS Phone Number: 623-776-7766 | Fax: 623-776-7767
ACCS Email Address: counseling.accs@gmail.com
Initial Intake / Screening Fee: $85
referred for: program
education course
additional services
choose one by typing the program name into the box below.
choose one by typing the course name into the box below.
type the service name in the box below.
We will be in touch soon!
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