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  • CONTACT US
  • HOME
  • PROGRAMS
  • ELECTRONIC MONITORING
  • ONLINE COURSES
  • CLIENT FORMS
  • PAYMENTS
  • EMPLOYMENT
  • CONTACT US

CLIENT FORMS

In an attempt to make more resources available online for clients, please see the below forms to utilize for any appointments attempted to be made virtually. By downloading, filling out, and sending back to EMASS staff, you the client, are giving EMASS permission to put the submitted information toward your client file. We apologize for any inconvenience this may cause; EMASS is trying to be available for clients during this unprecedented time. 

Probation Forms

Below is the monthly Client Supervision Form. Please ensure it is sent to EMASS (by mail, fax or email) by the 15th of each month.

Please make sure you are viewing the documents correctly. Click 'Enable Editing' after downloading  so you can fill in your information before emailing/faxing/mailing back to EMASS.
Client Supervision Forms
File Size: 44 kb
File Type: doc
Download File


REACT

REACT Client Copies
File Size: 608 kb
File Type: pdf
Download File

REACT Pre/Post Test
File Size: 117 kb
File Type: pdf
Download File

Alcohol & Family Dynamics
File Size: 121 kb
File Type: pdf
Download File


SATOP

​Please make sure you are viewing the documents correctly. Click 'Enable Editing' after downloading  so you can fill in your information before emailing/faxing/mailing back to EMASS.
Client Orientation
File Size: 41 kb
File Type: doc
Download File

HIPPA Acknowledgment
File Size: 36 kb
File Type: doc
Download File

Voluntary Consent for Tx
File Size: 39 kb
File Type: doc
Download File

Federal Regulations Notification
File Size: 36 kb
File Type: doc
Download File

Client Rights
File Size: 47 kb
File Type: doc
Download File

Client Responsibilities
File Size: 42 kb
File Type: doc
Download File

DMH/DOR Release
File Size: 40 kb
File Type: docx
Download File

Release of Information
File Size: 33 kb
File Type: docx
Download File

Financial Responsibility
File Size: 49 kb
File Type: doc
Download File

Notice of Cost- CIP
File Size: 59 kb
File Type: doc
Download File

Notice of Cost- SROP
File Size: 65 kb
File Type: doc
Download File

Confirm for Receiving Tx Plan
File Size: 47 kb
File Type: doc
Download File

Confirm for TX Plan Participation
File Size: 35 kb
File Type: doc
Download File

Notice of Privacy Services
File Size: 38 kb
File Type: doc
Download File

SMT Information
File Size: 34 kb
File Type: doc
Download File

SNAP Assessment
File Size: 24 kb
File Type: doc
Download File

Chemical Dependency Self Assessment
File Size: 33 kb
File Type: doc
Download File

Mental Health CAGE Aid
File Size: 18 kb
File Type: xlsx
Download File

AA Meeting Form
File Size: 58 kb
File Type: pdf
Download File

Client Orientation Packet
File Size: 153 kb
File Type: doc
Download File

For A New Beginning, Contact Us


Corporate Hours:

M-F:
​8am - 5pm
OR BY APPOINTMENT

Corporate Phone:

Register for a Class or Program:
​
​636-946-2815

Electronic Monitoring Phone:

​Sign up for GPS, House Arrest or Alcohol Monitoring:
​
636-946-5315 

Email:

[email protected]