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Release of Information-SUD


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

To complete the application by hand:

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

You may also download this form, scan and return by


or Mail to: Western Montana Mental Health Center

1321 Wyoming St, Missoula, MT  59801 

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