Intake & Insurance Form

Get in Touch

Contact our Admissions Director, Bridget, at Wildflower Mountain Ranch

(801) 835-9359

Parents First & Last Name

Daughters First & Last Name

Daughters Date of Birth

Phone Number

Share a little about what’s bringing you here and what you’d like support with.

Address

Will You Be Using Insurance?

Yes

If Not, Please Give Us More Information

If So, What Insurance? ID Number?

Upload Insurance Card

Schedule an appointment

July 2026

Week starting Sunday, July 12

Time zone: Coordinated Universal Time (UTC)Phone call

Monday, Jul 13

10:00 AM - 11:00 AM

11:00 AM - 12:00 PM

12:00 PM - 1:00 PM

1:00 PM - 2:00 PM