This is a HIPAA-compliant, secure form. We value your privacy, and access to your questionnaire is limited to our Client Care Coordinator and pertinent clinical staff of UCEBT.
Please look for the confirmation message at the end of your screen to ensure that your responses have been recorded.If for any reason you do not hear from us within 2 business days, please reach out to our Client Care Coordinator at (801) 419-0139 Extension 2. We look forward to connecting with you!
*If you are in need of immediate MH support or crisis intervention, please instead reach out to the National Crisis Hotline at 1-800-273-8255, call 911 or go to your nearest ER.