Balance and Stability

707 W 7th Ave Ste 200 Spokane, Washington 99204

Phone - (509) 850-1080 I Fax - (509) 461-2532

Evidence-based, comprehensive behavioral support, education, developmental training, and crisis intervention.

Request An Appointment

We are very excited to work with you! Please use this form to tell us a little bit about how we can best help, and we will contact you as soon as we are available to. If you need immediate assistance, give us a call and we will be happy to help in any way we can.

Your Name

First Name

Last Name

Phone

(###)

###

####

Email Address

Age of individual needing services

Diagnosis

(List all that apply)

Date of Diagnosis

Month/Year is okay

Primary Insurance

Identify the name of the insurance company serving as primary. If you do not have insurance, please indicate "Private Pay."

Secondary Insurance

(if applicable)

In a few words, describe how you hope we can help.

Availability of Individual Needing Services

E.g. mornings, afternoon, after school, evenings