As Amudim prides itself on maintaining the most up to date information so we can best serve our clients, we ask that you please complete this form, so that we can keep our database as up to date as possible. 

Question for Therapy/Clinic Specific
Program Location:
Do you have multiple locations?
Primary Contact Person information:

Please enter information about your program:

Genders Served
Is this program LGBTQ+ friendly?
Services Offered:
Age of clients served
What languages do you provide services for
Areas addressed (select all that apply)
Please select the treatment modalities offered at your clinic:
Cost of treatment in USD
Cost of Intake in USD (if applicable)
Do you accept insurance?
Is your clinic exclusively private pay?
How is your clinics insurance taken care of?
Does your clinic offer a sliding scale?
Does your clinic offer a discount for Amudim clients?
Does your clinic assist clients in obtaining Single Case Agreements from their insurance?
Does your the clinic offer scholarships?