Referral to Treatment Service - Application

Thank you for your interest in working with Mental Health America on our MHA Screening platform. We are excited to list treatment resources for individuals using the site. Please fill out the questions about your service or services below as accurately as possible using the content you want the end user to see. If you have any questions, please contact Kevin Rushton at krushton@mhanational.org.

Note: When applicable, MHA recommends providing custom tracking URLs for all links to your website, including download links for apps.
Looking for a different application?
If you want to feature a DIY Tool (app, worksheet, book, etc.), click here.
Please describe your organization or service in 50 characters or less.
Upload an Icon.
Upload requirements
MHA requires that each person who lists a treatment service has a direct phone or email contact for its users. Please provide either a phone number or an email--a link to a "contact us" form or a ticket system is not enough.
Tell us more about your organization/service in 5-7 sentences.
Please indicate the source.
We want to make sure that any pricing information is clear and easy to understand for the consumer. Please provide a plain language description of your pricing as well as a link to full details. If there is no cost, please state that here.
We want to make sure that any of our visitors fully understand how you will collect their data and what you might plan to do with it. If you are required to comply with HIPAA, please state here. You should include a brief, plain language summary of your privacy policy, letting people know how their data may be stored and/or shared. You must also provide a link to your full privacy policy.
Please include any other information that is relevant for your service in terms of disclaimers and liability. For example, if you work with individuals under the age or 18 or with legal guardians, include a statement on how you gain permission to work with them, referencing applicable law or regulation. You may also include a link to your full disclaimer. MHA may contact you for further information in this area.
Appropriate Conditions (This treatment services is appropriate for:)
Which conditions or populations is this service qualified to treat? Please note: it is important to be honest here. If a service isn't appropriate for someone with an eating disorder, don't suggest it! MHA reserves the right to finalize this list.
Select Service Type & Settings
Which of the following best describes the type of service you provide? Check all that apply.
Ages served
Who can MHA contact for further questions about your application or service? Generally this should be the person completing the form.