Thank you for choosing Mala Child & Family Institute as your partner in care. Please complete this form as the first step of your enrollment process.

To help us match you with a provider as quickly as possible, we kindly ask that you offer the most flexible availability you can. If your schedule is limited to evening appointments, please note that you may experience a longer wait for care.

We appreciate your understanding and look forward to supporting you and your family on this journey.

If individual therapy is the best fit for your child, we strongly encourage considering a daytime appointment instead of waiting for an after-school slot. We will provide a note for the school and collaborate closely with teachers to support both your child’s mental health and academic success. 

NEXT: SECOND CONTACT INFORMATION

Please read carefully and provide accurate details.

For Minors Under the Age of 18:

Divorced/Separated Families: Contact #2 must be the child's other parent. If both parents have legal custody, provide both parent #1 and parent #2's email and phone number. Forms will be sent to both parents—please do not list the same email twice.
Non-Divorced/Separated Families: Contact #2 can be any trusted adult (e.g., parent, grandparent, stepparent).

For Couples Therapy:

Contact #2 must be your partner, as they need to receive paperwork to enroll.

For Individual Adult Therapy or Others:

If a second contact is unnecessary, write "N/A" in the fields and enter "0000000000" for the phone number.