SMALL-TALK MENTAL HEALTH INTEREST FORM

CM & CENTERSTONE MENTAL HEALTH INTEREST FORM
Community Montessori is excited to announce a new partnership with Small-Talk (https://smalltalk-clinic.com/, 812-903-9633), located in New Albany, bringing additional in-person mental health services right to our campus starting in November 2025! Please fill out this Interest Form for children or teens program. Teen and younger capable learners will walk independently to the Courage Cabin for sessions, while some elementary-aged learners may be walked up the hill to the Courage Cabin or meet in the main building. Please contact Aimee Joy or Barbara Burke Fondren with additional questions. Fill out this form to start the intake process and get on the schedule before spaces are filled.

Learn more HERE!
Date*

MonthDayYear
Date
Learner's Name*
Teacher/Studio*
Date of birth*

MonthDayYear
Date
Gender at Birth*
Grade Enrolled*
Address*
City*
State*
Zip Code*
Parent/Guardian Name*
Parent/Guardian Phone*
Insurance Provider information*
(Insurance information varies based on the provider.)
Reason for mental health services (Once you submit, this information will be shared with the school liaisons and Small-talk. All information will be kept confidential):*
Should be Empty:

CM & CENTERSTONE MENTAL HEALTH INTEREST FORM