Secure Self-Referral Form
Are you enrolled with Vocational Rehabilitation

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*Potential clients must be referred by DES Vocational Rehabilitation, or if they are receiving AHCCCS health benefits and are enrolled with either Arizona Complete Health (AZCH), Banner Health, American Indian, or United Health Care, they can complete a self-referral and will meet with our staff for a clinical assessment to determine eligibility.  

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DKA is an Arizona Health Care Cost Containment System (AHCCCS) Specialty Provider. 

DKA, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. DKA provides culturally and linguistically appropriate services and reasonable accommodations for people with disabilities. If you believe your rights have been violated you may file a grievance in person or by mail, fax, or email to DKA, Inc., 1502 E. Broadway, Tucson AZ 85719 or Phone: 520 790-7677; Fax: 790-7786; or Email: Receptionist@Dkajobs.com

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 800-537-7697 (TDD) Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html