Windhorse IMH Preliminary Application Form
Please take the time to complete  and submit this preliminary application (5-10 min) and someone from our admissions team will call you for an in-depth telephone conversation and to discuss a visit to Windhorse within 24 hours.
We so look forward to meeting you.
Begin
 
Prospective Client Information (5 questions)

 
Legal name of prospective client? *

 
Preferred name?

Nickname or an alternative name that client may prefer to be called.
 
Date of Birth *

 
Gender?


 
Preferred Pronoun?


 
Address? *

Example:
123 Main St.
Apple Pie, California 00000

If you are not the prospective guest and do not have or cannot share this information, you can simply note: "Not guest?" There will be room for you to give us your contact information below.
 
Telephone Number? *

Example:
(999)-999-9999

If you are not the prospective guest and do not have or cannot share this information, you can simply note: "Not guest?" There will be room for you to give us your contact information below.
 
Best time to call?

example:
Between 9-5pm (Mon, Tues, Fri)  or Anytime.
 
If you are NOT the prospective client, please fill in this next section:

 
Please enter full name

(Prefix) First name, Last Name
 
Full Address

ex.
123 Main St.
Austin, TX 00000
 
Phone #: *

ex. (999)-888-7777
 
Relationship to client:

 
The following questions will allow you to elaborate further about your situation:

 


Please outline your current situation. Information about current or recent treatment and hospitalizations is especially helpful. This will give us the context for our more detailed conversation. *

 


How would you like your life to change through your involvement with Windhorse? *

 

What medications are being prescribed currently, if any? *

 


When do you need a Windhorse program to begin? *

Submit a date or approximation (ie asap, this winter or year)
 
Which Windhorse location are you most interested in? *

No worries, you are always welcomed to change your mind.



 
How did you hear about Windhorse? *


Thank you for completing this Admissions form. We will review it and contact you within a 24 hour period. 

In the meantime get to know our incredible Admissions team.
They will guide you from the first phone call until you or your loved one is at home at Windhorse.
Meet the Admissions Team
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