Treatment Center Information Survey
Thank you for your participation in Mental Health Initiative's Nationwide Residential Treatment Directory!
We appreciate you joining us in our mission to make mental health treatment more accessible. We understand your time is valuable, and that this survey is detailed. For updates, you will NOT have to fill out the entire survey every time,  we will just ask you to review your prior submission and advise us of any changes. If you have any questions on any of the items below, give us a call at 615-212-9710 or email us at directory@mentalhealthinitiative.info.

Thank you for your time!
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Email *
Full name of treatment center: *
Directory point of contact name:  *
Directory point of contact phone number: *
Directory point of contact email address (if different than one provided above)
Admissions point of contact name and phone number for prospective families/clients: (if different from directory point of contact) 
Where is the treatment center located? (city/state) *
Is your treatment center a locked facility? *
Are you a Community Based Treatment Center? *
Required
How many beds does your treatment center have? *
What ages do you treat? (check all that apply) *
Required
Duration of treatment offered: (check all that apply) *
Required
Check any insurance carriers you are in network with: *
Required
Identify what types of mental health disorders your program treats: (select all that apply) *
Required
Please list your program's exclusionary criteria: (what would prevent someone from admitting to your program)
Identify family involvement: (Check all that apply) *
Required
Optional: Describe your family program/philosophy in additional detail
What type of additional components of therapy do you offer? (Check all that apply)
Identify what types of problems your program treats: (Check all that apply) -This will be a way for clients/families who do not identify with/understand mental health diagnoses to search for treatment centers who can support their needs *
Required
Animal Policy: (check all that apply) *
Required
Do you accept non U.S. citizens? *
Please identify what additional levels of care are offered/available: (check all that apply) *
Required
Does your treatment center have onsite psychiatric care? *
Does your treatment center have shared/private rooms? *
Please identify what a typical week of programming looks like: (How many individual therapy sessions, how many group sessions, psychiatry, nutrition, etc) *
Are electronics Allowed? *
Describe your electronic policy/philosophy in further detail *
Is Visitation Allowed? (family/friends) *
Do you offer any faith-based services? 
Clear selection
Does your treatment center have bilingual therapists on staff currently? NOT interpreter services. *
Does your treatment center have a dietician onsite? *
Please describe your treatment center's nutrition philosophy & program details *
Please share any accreditations your treatment center has:  *
Required
What is your program's out-of-pocket self-pay rate? We understand this is not typically advertised, but in an effort to be as transparent as possible we do request an actual number or number range in this answer. You can share this information however makes the most sense for your treatment center (please identify if this number is you daily rate, monthly rate, etc) and we are absolutely open to broad price ranges, and identification of sliding scale options that are available.  *
If your treatment center has any current information sheets (one-pagers/digital flyers/brochures) you would like to be included on your information page within our directory, please email the materials directly to directory@mentalhealthinitiative.info after you have submitted this survey. These can be updated every time your survey is updated, or by request in between updates.
A copy of your responses will be emailed to the address you provided.
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