• Contact Us

    Thank you for your interest in services at St. Louis Behavioral Medicine Institute! We know that reaching out for help can be hard and we want to make sure we provide you with the best treatment experience possible. To help us accomplish this, we ask that you submit the following form in order for one of our intake specialists to contact you with more information about scheduling.

    What if I am under 18 years old?
    We also ask that minors who are under the age of 18 have their parents or legal guardians complete this form for them.

    What if I am filling this form out for someone else?
    In order to protect the privacy of others, we ask that adults over the age of 18 to not complete this form for any other adults (unless otherwise noted by power of attorney or legal medical guardianship). Parents or legal guardians are asked to complete this form for any children below age 18.

    Do you accept insurance?
    We accept most major insurance companies, but we do not accept the Medicaid Primary and Ambetter. We are always happy to check your insurance benefits for you.

    What if I am having a crisis?
    If at any time you feel you need immediate and critical assistance, please present yourself to the nearest Emergency Department, call the Crisis Hotline (Behavioral Health Response: 314-469-6644 or Provident St. Louis 24-hour Crisis Line: 314-647-4357) or call 911. Please do not wait for a return call from the intake specialists if you are in need of immediate and critical assistance.

    What should I do next?
    When you are ready, go ahead and click the “next” button below. The form will appear and the information you submit will help us best help you with your treatment experience.

    What happens after I submit this request?
    After you submit your form, our intake specialists will be in contact with you within 24 business hours. We will make every attempt to honor your call preferences. But to respect your privacy, our specialists will not contact you more than two times without a response. When you speak with our intake specialists, please make sure you have information about your current and/or past treatment and medication experiences.

    We look forward to speaking with you!

    Request for Appointment Form