New Client Intake Form

Imagine Living Solutions (ILS) provides support services to eligible New York State residents who may benefit from assistance with behavioral health, special needs, addiction-related challenges, or related wellness and support needs.

To be considered for services, applicants must meet the following basic eligibility requirements:

– New York State Residency: The applicant must currently reside in New York State.

– Identified Support Need: The applicant must be experiencing at least one of the following:

  – Addiction or substance-use-related challenges.

  – Special needs or developmental support needs.

  – Behavioral challenges requiring support or intervention.

  – Related wellness or daily-living challenges that align with ILS program offerings.

– Service Alignment: The applicant’s needs must align with the services currently offered by ILS.

Meeting these initial requirements does not guarantee acceptance into an ILS program. Eligibility, service availability, and suitability will be assessed during the intake process.

If you are completing this form on behalf of a child, family member, or another individual, please provide the applicant’s information where requested.

Step 1

STEP 2

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