Waitlist Sign Up

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Waitlist Sign Up

TREE House of Greater St. Louis (TH) currently has a waitlist for services. You must complete the below form to be added to the TH waitlist and by submitting the below form you hereby agree to email, phone, and other electronic communication. When space is available, applicants will be contacted for follow-up conversation and completion of intake paperwork. When paperwork is completed, an assessment is scheduled with TH professional staff to support the appropriate service placement. Only upon completion of this assessment will TH professional staff determine if an applicant is eligible to start. Thank you for your patience as we work diligently to reduce our waitlist as quickly as possible!

Email *

Contact Name *

Phone *

Client Name *

Client Age *

Has the client been determined eligible for Department of Mental Health (DMH) services? If yes, please enter the client's DMH number below. If no, please enter "no". *

County of Client Residence *

St. Charles County

St. Louis County

Other:

Service of Interest (select all that apply) *

Physical Therapy

Occupational Therapy

Mental Health / Counseling

Adaptive Therapeutic Riding

Speech and Language Therapy (not currently offered)

Camp

Freedom Reins

To Be Determined

Required

Method of Payment *

Please select all that apply.

Regional Center (Department of Mental Health)

Medicaid

Private Pay

Variety

Insurance - We are not currently accepting new clients with private pay insurance as a primary method of payment. Please list name of insurance company in the "other" field below.

Other:

Required

Availability *

MonAM

MonPM

TueAM

TuePM

WedAM

WedPM

ThuAM

ThuPM

SatAM

SatPM

Select all that appy

Referral Source

Comments

Submit

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