Booking an Appointment
Before booking an appointment, we first need to assess your eligibility and ensure our services are the right fit for your needs. Please complete the screening form below and click the submit button. A member of the EOMHC team will contact you shortly to schedule your appointment.  

If you need emergency services (police, Hospital ER, EMS, Fire), please call: 911.
If you are in CRISIS, please call: 918-649-0011.
If you need help filling out this data, or have questions, please call: 918-649-0011.
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First Name - Last Name - (Maiden Name) *
If applicable, please put your maiden name in parenthesis
so that we may validate you information correctly.
Phone # *
Social Security # *
Date of Birth *
MM
/
DD
/
YYYY
What City do you live in? *
What State do you live in? *
Which of the following pay sources, if any, do you have?
Not having a pay source does not prevent consumers access to services.
Submit
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