Tanager Place

Treatment Inquiry

MM slash DD slash YYYY
Caregiver Name(Required)
Providing an email address, if available, helps us connect you to needed services as efficiently as possible.
Caregiver Address(Required)
Client Name(Required)
MM slash DD slash YYYY
Client Address(Required)
Current Tanager Place client?(Required)
Interested Services
Please include information about current symptoms, behaviors, functioning and trauma

Insurance & Documentation

Please attach copy of insurance card and ABA documentation, if applicable, in upload section below. Insurance verification required before appointment. Tanager Place is unable to accept Medicare insurance at this time. Private pay rates are available for insurances out of network. While insurance information is not required as part of this form, providing it now will expedite the path to treatment.
Name on Medicaid/MCO Card:
Private Insurance: Subscriber's Name
MM slash DD slash YYYY
Drop files here or
Accepted file types: jpg, pdf, png, gif, Max. file size: 256 MB.

    We’re here to help.

    If you (or someone with you) are experiencing a medical emergency, or are in danger, call 911 immediately.

    If you are experiencing a mental health crisis or feeling suicidal, call or text 988 immediately.

    Your Life Iowa:                      (Facilitated by Foundation 2)

    Suicide and Crisis Lifeline:

    General Information: