If you cannot call Siouxland Mental Health Center, please use the form below to submit a confidential request to our admissions staff. We will get back to you as soon as possible.

​

For any requests other than medical attention, please call us directly.

​

If you are in a crisis or need immediate help, please pause filling out this form and call 911.

​

If you feel you are a danger to yourself, please pause filling out this form and contact the National Suicide Prevention Lifeline at 988 or call 911.

​

If you cannot call Siouxland Mental Health Center at (712) 252-3871, please use the form provided below to submit a confidential message to our admissions staff. We will respond as soon as possible.

​

Please note that by leaving your contact information in the space provided, you consent to allow Siouxland Mental Health Center to use this information to contact you. Any information provided will remain confidential. Please note that by choosing not to leave your information, the staff at Siouxland Mental Health Center will not contact you.