Youth Behavioral Health -Request Services

Youth Behavioral Health -Request Services

Request Youth Behavioral Health Counseling
“Please complete the form below to request services through our Youth Behavioral Health Counseling Program. A team member from The Way Resource Center will contact you within 2 business days.”
Parent / Guardian Name*

First NameLast Name
Youth's Name*

First NameLast Name
Youths Age*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Best Way to Contact You

PhoneEmailEither
Type of Support Needed
Type of Support Needed

Individual Counseling (youth)Family CounselingAnger ManagementAnxiety / DepressionTrauma / Grief CounselingOther
Preferred Session Format
Additional Notes
Should be Empty: