THE MIND NEST PLACE MENTAL HEALTH INTEREST FORM

THE MIND NEST PLACE MENTAL HEALTH INTEREST FORM
Community Montessori is pleased to share a partnership with The Mind Nest (kaitlin@themindnest.org, 812-227-6333), located in New Albany, for mental health services for our children and teens. Starting in February 2025 (in addition to services currently being provided by Centerstone and Katelyn's Place), children and teens (9 years and older) can receive in person therapy sessions on our campus. All major commercial providers, including Aetna, Anthem, Cigna, United/Optum, and Ambetter Indiana, are accepted, but they can only accept Anthem-sponsored State-Sponsored health insurance (Medicaid) at this time.

Teen and younger capable learners will walk independently to the Courage Cabin for an IN-PERSON session while some elementary-aged learners may be walked up the hill to the Courage Cabin or meet in the main building.

Fill out this form to start the intake process and get on the schedule before spaces are filled. The intake process will be coordinated by The Mind Nest and Community Montessori will provide the space for on campus therapy.

Please contact Aimee Joy or Barbara Burke Fondren with additional questions.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Learner's Name
Teacher/Studio
Date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Current Age
(9 years and older only)
Address
City
State
Zip Code
Parent/Guardian Name
Parent/Guardian Phone
Format: (000) 000-0000.
Parent/Guardian Email:
example@example.com
Insurance Provider information
All major commercial providers, including Aetna, Anthem, Cigna, United/Optum, and Ambetter Indiana, are accepted, but they can only accept Anthem-sponsored State-Sponsored health insurance (Medicaid) at this time.
Reason for mental health services (Once you submit, this information will be shared with the school liaisons and The Mind Nest).
Should be Empty: