Welcome to Astra Mental Health & Recovery

We know how tough it is to live with mental health or substance use challenges. All of us at Astra want the best for you and your family. Whether you live with anxiety, depression, ADHD, trauma, substance use or other challenge, Astra is here to assess what’s going on and provide the appropriate treatment.

The fastest, easiest way to get started is to pre-register. Once you complete the form and click “Submit,” an Astra staff member will call to set your first appointment.

Fill in the spaces below and click “Submit” when finished to send your form to us. Astra Admissions will contact you to help you get started. (NOTE: An asterisk * indicates required information.)

Pre-Registration Form

"*" indicates required fields

Comments

This field is for validation purposes and should be left unchanged.

First Name*

Last Name*

Person seeking services*

Yourself

Your Child

Child's First Name*

Child's Last Name*

Best phone number to call*

Best time to call between 7:30 a.m .and 5 p.m.*

Who referred you for services?*

What are your concerns?*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email of person seeking services*

Date of birth for person seeking services*

School, if applicable

Current grade, if applicable

Doctor's name*

Do you have insurance?*

Yes

Insurance Information

Insurance Company*

Insurance ID#*

Insurance Group #*

Insured Name*

Insured Date of Birth*

Insured Employer

Insured Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Welcome to Astra Mental Health & Recovery

Pre-Registration Form

Pre-Registration Form

Insurance Information

Contact

Hours

Welcome to Astra Mental Health & Recovery

Pre-Registration Form

Pre-Registration Form

Insurance Information

Request Appointment