Waitlist form
Welcome and thank you for applying to our waitlist!  

By filling out this form, you are consenting to being contacted by Healing Mountain Mental Health in the future via your preferred communication method when a spot opens.  Please note that if a reply is not received in the course of 2-3 business days, you will be moved down the list.  Mental health care is highly sought after in the community, and we must ensure that we are doing our best to provide treatment to those in need. 

Also, please note our credentialed insurances on our website at https://www.healingmountainmentalhealth.com/online-payments--insurance-information.html

Before being scheduled, we have a quick verification of benefits process to ensure that mental health services are covered under your policy.  If your insurance is out of network, please be aware that we cannot bill your insurance and you will have out-of-pocket payments.  Standard fees for therapy are $150, but we may be able to do a sliding fee scale if you are within or near the poverty or low-income limit.  

We will contact you in the order that your form is received.  If you have found another therapist and wish to be removed from our waitlist, feel free to contact us via text, phone call, or email.  
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First name *
Last name *
Pronouns
Phone number *
Age *
Email
Insurance type *
Therapy preference *
Brief reason for seeking therapy: *
Referred by:
Communication preference: *
Please specify if you have any mobility constraints or accessibility requirements, such as an elevator or ramp.  
Preference for appointment time *
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