Patient Sign Up

Whether you’re in treatment or looking to make improvements for the first time. Cloud 9 delivers licensed, clinical care with the highest level of privacy wherever you are and whenever you need it.

In Treatment?

If you ARE working with a mental health provider or healthcare organizations, please enter their contact info here so that we can get you both “On Cloud 9” as quickly as possible:

CONNECT MY PROVIDER HERE

Your First Name*

Your Last Name*

Email*

Info for your psychiatrist, counselor, therapist or social worker

Your Doctor's First Name

Your Doctor's Last Name

Your Doctor's Email

Your Doctor's Phone

Info for your hospital, or health providing organization

Organization's Name

Organization's City

Organization's State

How did you hear about us?

New Patient?

If you are NOT currently working with a mental health provider, please enter your information and we will attempt to match you with a provider as soon as possible.

MATCH ME WITH A PROVIDER HERE

Your First Name*

Your Last Name*

Email*

State of Residence*

What is your biggest concern right now?*

How did you hear about us?*