Request an Adult Intensive Outpatient Program (IOP) Assessment
Please fill out the following information. Our Adult IOP Coordinator will be in contact by the next business day. If you have any trouble with this form call Renew at 913.768.6606 and press 0.

Click here to submit an Adolescent IOP Eligibility Form:

To schedule for once a week outpatient therapy for eating disorders, dietician services or couples counseling (our individual anxiety therapists are currently full)  NOT IOP (which is group therapy for 18 sessions over 6 weeks click here:
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Email *
Name *
This form is only for adults seeking a free assessment about eligibility to join the Adult Intensive Outpatient Program.
Age *
Best Contact Number? *
May we leave a voice message? *
E-mail Address
Preferred method of contact? *
Payment Method? *
If insurance, what insurance provider?
Who referred you?
May we contact the person who referred you to thank them?
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Name of person who referred you:
Is there anything else you think would be important for us to know?
A copy of your responses will be emailed to the address you provided.
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