Skip to content
Donations
Make a Donation
In-Kind Donations
For Members
Medical Records Request
Member FAQ
Have a Concern?
Request an Appointment Online
Donations
Make a Donation
In-Kind Donations
For Members
Medical Records Request
Member FAQ
Have a Concern?
Request an Appointment Online
Facebook
Twitter
Instagram
Linkedin
Services
Need help? Start Here.
Obtaining Services
Eligibility for Services
Accepted Insurance Plans
Request an Appointment Online
Behavioral Health Services
Behavioral Health Services Offered
Individual Therapy
Group Therapy
Peer Support Services
Certified Community Behavioral Health Center (CCBHC)
ReEntry Services
Youth Services
Thrive Youth & Family Services
Therapy
Life in Full Throttle (LIFT)
Pima Prevention Partnership & Partnership Schools
Substance Misuse & Recovery
Opioid Treatment/Medication Assisted Treatment (MAT) & MOUD
Methamphetamine Recovery Program (MRP)
Project Elevate
Wellness on Wheels - WoW
Community Health Services
Services Offered
Insiders Program (HIV & Sexual Health Services)
Wellness on Wheels - WoW
Housing & Homeless Services
NEXUS Program
Medical Services
Medical Services Offered
Psychiatric Evaluations & Assessments
Residential & Apartment-based Programming
Behavioral Health Residential Program
Therapeutic Day Programs
Housing Opportunities
Job Training
Employment Services Program
—
Clinics & Locations
Hours and Locations
Wellness on Wheels Location Schedule
Join Us
Careers at COPE
Pay, Benefits and Culture
About
Our Legacy
Our Impact
News & Events
Mission, Vision & Values
COPE’s Leadership Team
By the Numbers
Get Involved
Donate Now
Make an In-Kind Donation
News & Events
Join our mailing list
Contact
Services
Need help? Start Here.
Obtaining Services
Eligibility for Services
Accepted Insurance Plans
Request an Appointment Online
Behavioral Health Services
Behavioral Health Services Offered
Individual Therapy
Group Therapy
Peer Support Services
Certified Community Behavioral Health Center (CCBHC)
ReEntry Services
Youth Services
Thrive Youth & Family Services
Therapy
Life in Full Throttle (LIFT)
Pima Prevention Partnership & Partnership Schools
Substance Misuse & Recovery
Opioid Treatment/Medication Assisted Treatment (MAT) & MOUD
Methamphetamine Recovery Program (MRP)
Project Elevate
Wellness on Wheels - WoW
Community Health Services
Services Offered
Insiders Program (HIV & Sexual Health Services)
Wellness on Wheels - WoW
Housing & Homeless Services
NEXUS Program
Medical Services
Medical Services Offered
Psychiatric Evaluations & Assessments
Residential & Apartment-based Programming
Behavioral Health Residential Program
Therapeutic Day Programs
Housing Opportunities
Job Training
Employment Services Program
Clinics & Locations
Hours and Locations
Wellness on Wheels Location Schedule
Join Us
Careers at COPE
Pay, Benefits and Culture
About
Our Legacy
Our Impact
News & Events
Mission, Vision & Values
COPE’s Leadership Team
By the Numbers
Get Involved
Donate Now
Make an In-Kind Donation
News & Events
Join our mailing list
Contact
×
Services
Need help? Start Here.
Obtaining Services
Eligibility for Services
Accepted Insurance Plans
Request an Appointment Online
Behavioral Health Services
Behavioral Health Services Offered
Individual Therapy
Group Therapy
Peer Support Services
Certified Community Behavioral Health Center (CCBHC)
ReEntry Services
Youth Services
Thrive Youth & Family Services
Therapy
Life in Full Throttle (LIFT)
Pima Prevention Partnership & Partnership Schools
Substance Misuse & Recovery
Opioid Treatment/Medication Assisted Treatment (MAT) & MOUD
Methamphetamine Recovery Program (MRP)
Project Elevate
Wellness on Wheels - WoW
Community Health Services
Services Offered
Insiders Program (HIV & Sexual Health Services)
Wellness on Wheels - WoW
Housing & Homeless Services
NEXUS Program
Medical Services
Medical Services Offered
Psychiatric Evaluations & Assessments
Residential & Apartment-based Programming
Behavioral Health Residential Program
Therapeutic Day Programs
Housing Opportunities
Job Training
Employment Services Program
Clinics & Locations
Hours and Locations
Wellness on Wheels Location Schedule
Join Us
Careers at COPE
Pay, Benefits and Culture
About
Our Legacy
Our Impact
News & Events
Mission, Vision & Values
COPE’s Leadership Team
By the Numbers
Get Involved
Donate Now
Make an In-Kind Donation
News & Events
Join our mailing list
Contact
×
Search
Home
Services
Request an Appointment Online
Request an Appointment Online
All fields marked ‘required’ must be completed.
Dates are to be entered into stepper fields in the format MM / DD / YYYY, (as in 07/23/2013)
Name
(Required)
First
Last
Email
(Required)
Address
(Required)
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone
(Required)
Date of Birth
(Required)
Month
Day
Year
Gender
Male
Female
Other
Gender
Male
Female
Other
Other
Please elaborate on what "Other" means for you.
What type of services would you like to receive?
(Required)
Therapy
Primary Care
Psychiatry
Behavioral Health
Medication Assisted Treatment for Opioid Use
Methamphetamine Recovery Program (MRP)
Health Insurance Plan
AHCCCS/Medicaid
(Required)
Yes
No
Other
AHCCCS/Medicaid
Yes
No
Other
Please elaborate on "other"
Referral info
Comments
