AZ Office of Problem Gambling

  Arizona Office of Problem Gambling

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OPG forms for contracted providers
Billing Forms Excel spreadsheet available for download.  These forms must be downloaded and completed using Microsoft Excel in accordance with the TAP Provider Manual
Client Intake Form Adobe Acrobat file that can be downloaded or printed for copying for each new client served.  This form must be printed and completed in hard copy to be sent to the OPG
Client Satisfaction Survey Adobe Acrobat file that can be downloaded or printed for copying for each client terminating TAP services
G-SAS Adobe Acrobat file that can be downloaded or printed for copying for each client served. This form is required to be completed at the initiation and at the termination of TAP services for each client.  This form must be printed and completed in hard copy to be sent to the OPG
TAP Monthly Evaluation Form Adobe Acrobat file that can be downloaded or printed to be completed in hard copy and submitted to the OPG each month
Outreach Request Form Excel file that can be downloaded or printed to be completed in hard copy and submitted to the OPG to request approval for the provision of outreach services
Request for Interpreter Services Process and application form to request reimbursement for interpreter services for non-English speaking, deaf, and/or hearing impaired clients