Request an Appointment | Make a Referral
If you'd prefer speaking with our office prior to providing your information, please call our Client Care Coordinator at (406) 209-8711 or email info@bridgerpeakscounseling.com.
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Email *
Will this appointment be for you or are you making a referral for someone else?
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If you are referring for someone else:

Referral Source's Name
If you are referring for someone else:

Referral Source's Business Name
If you are referring for someone else: 

What type of organization are you referring from?
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First Name
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Last Name
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Client Date of Birth
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Phone Number
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Preferred Method of Contact

(By choosing “text” as a preferred method of contact on the Request an Appointment form, you are consenting to receive text messages from Bridger Peaks Counseling.  Text messages are used for scheduling, communication, and paperwork reminders.  Message and data rates may apply.
You can opt out of receiving text messages at any time by texting a request to stop or by calling 406-209-8711. )
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Please tell us what you would like help with so we can find you the best fit
Are you open to telehealth options?
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If you are open to Telehealth, are you located in Montana?
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Which location is best for you? *
Gender
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Parent or Guardian name if applicable
Date of Birth of Client's Parent or Guardian
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I’m interested in help with ...
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If you will be using insurance, what insurance do you have?
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Insurance member ID #
Please tell us how you heard about us
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If you heard about us from a source other than those listed above, how did you hear about us?
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