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Service Inquiry Form
Please provide information to assist us with prompt referrals and placements. Thank you.
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Email
*
Your email
Name of individual making the inquiry
*
Your answer
Phone number
*
Your answer
Preferred method of contact
*
Phone
Email
Required
Service inquiry type
*
Adult
Child (under 14)
Child (14 and over)
Family
Required
I'm interested in more information about the following service(s):
Please note that we do not provide medication management to individuals not currently involved in Glade Run services.
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Acute Partial Hospitalization
Blended Case Management
Family Based Services
Outpatient Counseling
Glade Run Adventures (therapeutic equine/animal/horticulture)
Independent Living Experience
Intensive Behavioral Health Services (IBHS)
Psychiatric Mobile Medication
Psychiatric Rehabilitation
St. Stephen's Academy (K-12, ESY, Transitions, Day Treatment)
School Based Mental Health
Unsure
Other:
Required
Office location preference
(
P
lease note not all programs are offered in all locations.
)
Beaver Falls
Butler
Frew Mills
Pittsburgh
Rochester
West View
Wexford
Zelienople
Other:
How did you hear about Glade Run?
*
Advertisement
Friend/Family Member
Insurance
Media Article
Online Search
Other Health Care Provider
Psychology Today
Social Media
Other
Required
A copy of your responses will be emailed to the address you provided.
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