Approved Care Network (Treatment Facility) Application

All fields marked with an * are required.

Thank you for your interest in joining our Approved Care Network (ACN). Before beginning this application, please have your facility's logo (in 300px by 300px or greater to display clearly on our site) ready as you will need to email it after you submit this form. Once you submit, you will be emailed a link to send the file.

Once your application is received, it will be reviewed for approval and you will be contacted to discuss your application further. If you are approved for our ACN, your logo will be used to display on our site.

Please know that we will be happy to update or remove any of your information if necessary if you contact us via the email below.

For any questions or concerns, please contact our Approved Care Network Team at: acn@healingtreenonprofit.org

We thank you again for your interest in joining our network and for the very important work that you do!

Ages 11 and under
Ages 12 - 17
Ages 18 and older
All ages
Inpatient Only
Outpatient Only
Both Inpatient and Outpatient
Female
Male
Transgender and Non-binary
Private Pay Only
Nonprofit - No cost
Scholarships Available
Insurance Accepted
Individual Therapy
Group Therapy
Supplemental Therapy (Trauma-Sensitive Yoga, Equine Assisted Therapy, Art Therapy, Drama Therapy, Music Therapy, Expressive Arts Therapy etc.)
Classes Provided
Referral Service Options For Ongoing Therapy
Yes
No
Yes
No
Yes
No
Age group treated
Bio of facility
Language(s) Spoken
LGBTQIA+ Friendly / Affirming
Name and contact information of Admissions Coordinator
Address, email, phone number and website of facility
Specific admissions criteria
Types of pay accepted
Types of treatment modalities available

Agreements & Submission

All fields marked with an * are required.

I certify that I have the authorization to submit this information and understand that Healing TREE will be verifying all of our information for accuracy, and that I have read and agreed to the following information on behalf of our facility:

 

a. If and once approved for their network, I realize it is our responsibility to notify Healing TREE within 30 days should our name, address, or status change.

 

b. In the rare instance that a client requests that a team member of Healing TREE discuss their progress with us, I understand that we must obtain a signed request from the client directly and that copy of this request will be emailed to Healing TREE to also keep on file.

 

c. If approved for Healing TREE's Approved Care Network, we agree to keep record of the clients that find our facility through Healing TREE and will make that information available to Healing TREE in aggregate form (such as total counts, types of issues dealt with) whenever requested. (Note: Healing TREE will never request PHI for an individual client.) I acknowledge that the facility and providers there alone are responsible for their care and practice. I also understand that Healing TREE has the right to remove our facility from their website at any time.

 

We will notify you shorty regarding the status of your application. Should you have any questions, please contact our Approved Care Network Team at: acn@healingtreenonprofit.org

 

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