Intake Interest Form

Thank you for your interest in services at Kanza Mental Health & Guidance Center.

To begin the intake process, please complete and submit the Same Day Access Intake Interest Form. This form allows our team to gather basic information and determine how we can best assist you.

 

What to Expect:

1. Complete all required fields on the form.

2. Submit your information electronically.

3. A member of our team will review your submission and contact you as soon as possible to discuss next steps and scheduling.

 

Please Note:

• Submission of this form does not guarantee a same-day appointment.

• Responses are reviewed during normal business hours.

• If you are experiencing a mental health emergency or crisis, do not wait for a response to this form. Call 911, go to the nearest emergency room, or contact the Kanza 24/7 Crisis Line at 785-742-3666 or the 988 Suicide & Crisis Lifeline by calling or texting 988.

 

If you have questions about the intake process or need assistance completing the form, please contact Kanza Mental Health & Guidance Center.

 

We look forward to helping you take the next step toward hope, healing, and wellness.