Ready to begin? Please complete the application form below.
If you are preparing to visit us, please review what to bring to treatment.
One of our experienced consultants will be reaching out to you soon.
The following information will be helpful when we contact you:
» Patient Information (Name/Address/Phone Number/Date of Birth/Social Security Number/Custody and/or Guardian Status)
» Reason for Referral
» Treatment History
» Current Outpatient Treatment Provider
» Previous Psychiatric or Chemical Dependency Treatment
» Primary Care Physician
» Insurance Information
» Insurance card(s)
» List of Current Medications
A Hope In The Mountains consultant will be in touch within the next business day. Thank you for your courage and interest.
Want to join our team? Hope In The Mountains is always ready to consider new applicants to support our growing and vital business.
Find value in helping others while advancing your own career.
Ready to begin? Please download the attached application form below.
Save the application form, above, to your computer. When it is complete, please attach it to an e-mail and return it to us here.
One of our human resource consultants will be reaching out to you soon if we select you to move forward with us.
Thank you for your interest in working with Hope In The Mountains.