BILLING & ASSISTANCE
Thank you for considering Siouxland Mental Health Center to provide services to assist with your mental health needs. Services received at Siouxland Mental Health Center and that you have elected to participate in require financial responsibility on your part. This responsibility obligates you to ensure payment in full of our fees. We will verify your coverage and bill your insurance carrier on your behalf. Payments are expected at the time of service.
It is the mission of Siouxland Mental Health Center to provide services for any person, family, and/or child(ren) who is in need of care, regardless of their ability to pay. Siouxland Mental Health Center continues to serve clients by offering services at reduced rates or free for those who qualify for Financial Assistance. Discounts are offered based on household size and annual income. Please complete the following information and return to the front desk to determine if you or members of your family are eligible for a discount.
The discount will apply to all services received at this Siouxland Mental Health, but not those services or equipment that are purchased from outside entities, including reference laboratory testing, drugs and other such services.
Download and complete the application form below. Along with a completed application please provide the following Federal Income Tax forms, W-2’s or last two consecutive pay stubs and valid photo I.D. to Siouxland Mental Health Center (Main Clinic location). We will review the information and get you scheduled with a therapist.
How do I apply?