Certified Community Behavioral Health Clinic Client Consent Form

Please complete the electronic form below.

 All fields marked (*) are required fields.  All information submitted on our website is private and confidential. Your treatment experience is strictly private and confidential, protected by federal and state law. 

If you need assistance in filling out our intake paperwork call 406-541-0024

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To complete the application by hand:

Please call 406-541-0024 to request a paper application be mailed to you.

You may also download this application, scan and return via

Email: referrals@wmmhc.org 

or Mail to: Western Montana Mental Health Center

1321 Wyoming St, Missoula, MT  59801 

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