Admissions & Referral Forms

Admissions Information

For information and appointments, call 307-439-2139

Step Down
Telehealth intensive outpatient programming can help teens discharging from inpatient and residential treatment continue to recover with group, individual and family counseling, without having to leave home.

Step In
Telehealth intensive outpatient programming can help teens struggling at home or in school who are not yet in need of acute inpatient psychiatric care or residential treatment.

Admissions Forms

Online Forms:

Outpatient Referral Packet
Outpatient Daily Check In
Crisis Safety Plan
Priority List

Downloadable Forms:

Release of Information

Seek Help Today

To speak with a member of our outpatient telehealth clinic team, give us a call at 307-439-2139 or you can reach us via email at [email protected].

Admissions & Referral Forms

Admissions & Referral Forms

Admissions Information

For information and appointments, call 307-439-2139

Admissions Forms

Seek Help Today

Priority List

PERSONAL CHECKLIST: RATE ANY OF THE FOLLOWING THAT APPLY TO YOU

Crisis Safety Plan

Recognize your warning signs and use your coping skills to keep yourself safe and healthy.

Outpatient Daily Check In

Safety screening

Columbia Suicide Severity Rating Screen

If yes to 2, ask questions 3, 4, 5, and 6. If No to 2, go directly to question 6

Risk Formulation

Interventions

Outpatient Referral Packet

Patient Information

Legal Guardian Information

Parent Information (if different than above)

Insurance Information (please include a copy of the insurance card)

Emergency Contact (will be contacted in the event of physical/mental health emergency)

Patient Questionnaire

Inpatient Program

Medications

Telehealth Assessment

Telehealth Assessment Participants

Access Questions