Clone of Nat-su Behavioral Health Treatment Application

The NAT-SU BHS Warrior Within Outpatient Program offers comprehensive mental health services tailored to your needs. We provide individual, couples, and family therapy, support for youth ages 5 and up, and dedicated case management to help you and your loved ones thrive.

If you are looking to apply for NAT-SU Behavioral Health Services’ Residential or Intensive Outpatient Substance Use programs, please click the link below:

Substance Use Treatment Application

Client Name*

First NameMiddle NameLast Name

Nickname(s)

Date of birth:

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

E-mail

example@example.com

Phone Number*

Race/Ethnicity

If you identify as Native American, what is your Tribal Affiliation?

Enrollment Number (if applicable):

How did you hear about Nat-su Behavioral Health?*

What services are you seeking(i.e. individual therapy, couples counseling, familial therapy, youth therapy, case management)?*

Therapy Application

Insurance Information