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Mental Health Waitlist Form

To process your request and add your child to the waitlist, please ensure all fields on this form are completed. We cannot proceed without the required information. Once we receive your completed form, your child will be added to the next available opening on our waitlist.

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Are you interested in: (Please check all that apply)(Required)
Which locations would work for you? (Please check all that apply)(Required)
When would your child be available for counseling? (Please check all that apply)(Required)
Please indicate your child's insurance coverage:(Required)

Idaho Falls Pediatrics is now
Just 4 Kids Pediatrics!

Learn more about this change and what this means for your pediatric care!

Learn More