Behavioral Health Appointment Request Form
Please fill out the form below if you are interested in scheduling an appointment with one of our behavioral health counselors. After submitting this form, you will be contacted from Scenic Bluffs within two business days.
Date of Birth:
Street Address Line 2
State / Province
Postal / Zip Code
Please enter a valid phone number.
How would you prefer to be contacted?
What is the best time to reach you?
8AM to 11AM
12PM to 2PM
3PM to 6PM
No one will be denied access for lack of insurance. If you do not see your health insurance company listed as an option below, it is likely that we do not have a therapist currently available for appointments that is enrolled with that insurance. This means that your insurance will not pay for services from our therapists. This list may change in the future.
My insurance isn't listed
Aetna Life Ins. Co.
American Healthcare Alliance (Exemplar Health)
Care WI / My Choice
Group Health Coop
Medica Mayo Medical Plan / Optum
MHS Network Health Plan/Centpatico
Security Health Plan/ Marshfield plan
United HealthCare Medicare Advantage Plan
United HealthCare Walmart-same as UHC
Should be Empty: