These are forms to be completed for virtual intake or in advance of in-person intake.
NOTE: You must complete the Intake form before completing the GAIN Screener. 

ADSTV Intake Form – Client

ADSTV Intake Form – Family or Significant Other

GAIN Screener (To be completed after Intake Form)

If you are a LiUNA Member and are seeking services with the Employee Assistance Program, please visit our LiUNA intake page.