Client Inquiry:

All prospective clients please  fill out the inquiry information to your right. If you have additional questions please reach out by phone or email. 

Office Phone/Fax/Email:

Phone: 253-312-8909  
Fax: 253-944-9062

Email: info@perchbehavioralhealth.com

 

 

 

 

Contact Name *
Contact Name
Phone *
Phone
Address *
Address
Child's Name *
Child's Name
Date of Birth *
Date of Birth
Primary Insurer Name *
Primary Insurer Name
Date of Birth *
Date of Birth
Customer Service Number (Providers) *
Customer Service Number (Providers)
Past Services Received *