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Treatment Centers
If you have a treatment center that treats clients who have experienced psychological trauma, childhood abuse, or dissociation, the Sidran Institute would like to list your services. To be included in our Treatment Centers Directory, please complete the questionnaire below. There is no charge for inclusion, and we thank you for the work that you do.

If you do not have a forms-capable browser, please e-mail us at forms@sidran.org or print out a PDF version, fill it out, and fax it to us at 410-560-0134. Otherwise, please fill out the form online and submit it to us.


(*) = required field
* Institution name :
* Street Address :
* City :
* State/Province :
* Country :
* Zip/Postal Code :
* Phone :
Extension :
* Fax :
* E-mail :
* Website :
* Intake/Contact Person :
* Clinical Director :
Name of trauma program (if different from the name of the institution above) :
* Year program began operation :
* Is this institution/program accredited? : Yes  No
If yes, please give name of the accrediting agency :
* Populations served : Children
Adolescents
Adults
Males only
Females only
* Specializations : Post Traumatic Stress Disorder
Dissociative Disorders
Eating Disorders
Males only
Self-Injury
Borderline Personality Disorder
Sleep Disorders
Depressive Disorders
Anxiety Disorders
Substance Abuse/Dual Diagnosis
Sexual Orientation/Identity Issues
Other relevant specialties :
* Philosophical Orientation (e.g. spiritual/religious) :
       Services and Capacity
* Inpatient/Residential : Yes  No
What is the capacity? :
What is the ratio of staff to clients? : Staff :  Client :
Please provide a description, admission criteria, and other information a prospective client would need to know :
* Emergency Shelter : Yes  No
What is the capacity? :
What is the ratio of staff to clients? : Staff :  Client :
Please provide a description, admission criteria, and other information a prospective client would need to know :
* Extended Care : Yes  No
What is the capacity? :
What is the ratio of staff to clients? : Staff :  Client :
Please provide a description, admission criteria, and other information a prospective client would need to know :
* Transitional Living : Yes  No
What is the capacity? :
What is the ratio of staff to clients? : Staff :  Client :
Please provide a description, admission criteria, and other information a prospective client would need to know :
* Halfway House : Yes  No
What is the capacity? :
What is the ratio of staff to clients? : Staff :  Client :
Please provide a description, admission criteria, and other information a prospective client would need to know :
* Intensive Outpatient : Yes  No
What is the capacity? :
What is the ratio of staff to clients? : Staff :  Client :
Please provide a description, admission criteria, and other information a prospective client would need to know :
* Outpatient/Walk-in Counseling/Therapy : Yes  No
What is the capacity? :
What is the ratio of staff to clients? : Staff :  Client :
Please provide a description, admission criteria, and other information a prospective client would need to know :
* School-Based Program : Yes  No
What is the capacity? :
What is the ratio of staff to clients? : Staff :  Client :
Please provide a description, admission criteria, and other information a prospective client would need to know :
       Therapy
* How many therapists are in your program? :
* What adjunctive therapies does your program offer? :
* Do you run therapy groups? : Yes  No
If yes, please describe :
* Do you sponsor peer-run support groups? : Yes  No
If yes, please describe :
* Briefly state your Center's treatment philosophy. What issues does your program focus on and how do you treat them? :
Describe the medical services available at your facility :
       Institutional Information
* Is your program affiliated with a hospital or medical center? : Yes  No
If yes, please name the institution and describe the relationship :
* What types of insurance do you accept? :
       Does your Center/Program provide
Financial assistance? : Yes  No
Sliding Fee Scale? : Yes  No
Payment Plans? : Yes  No
   
 
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