Select the appropriate link below to submit intake paperwork online. Paperwork should be completed by the individual seeking counseling; parents/guardians should complete Intake Form for children age 13 and under. Read the EACC HIPAA Privacy Statement.

Individual Intake Form

Couples/Families Intake Form

Children Under 14 Intake Form

Ages 14-19 Intake Form

Financial/Group Counseling Intake Form

One-At-A-Time Therapy Intake Form

Life Coaching Intake Form

Case Management Intake Form

Release of Information Form

TeleHealth Informed Consent

If this is an emergency...

If this is an emergency, defined as suicidal or homicidal thoughts, abuse and/or domestic violence, please call 911, or one of the numbers below. Or call the EACC front desk at 205-934-2281 during regular business hours to speak with a counselor.

  • Birmingham Crisis Center: 205-323-7777
  • 24hr Suicide Prevention Hotline: 1-800-273-8255
  • 24hr National Hopeline Network: 1-800-784-2433
  • Crisis Text Line: Text “UAB” to 741741
  • Alabama Domestic Violence Hotline: 1-800-650-6522

You can also go into any Emergency Room if you are feeling suicidal and seek assistance.