Get Help Now

Thank you for your interest in receiving 3-months of free remote mental health support through our partnership with BetterHelp. This program connects individuals (ages 13 and older) with a licensed therapist at no cost, with support available through video, phone, and text, making it flexible and accessible based on your needs.

Please complete the information below so we can better understand your needs and connect you with appropriate support.

⚠️ Important: This program is not intended for crisis situations. If you are experiencing a mental health emergency, please call 911 immediately or contact the 988 Suicide & Crisis Lifeline by calling or texting 988, or chatting via 988lifeline.org.

Upon completing this form, information on how to connect with a therapist will be sent to you via email. Your information shared here will be kept strictly confidential.

Your Name

First NameLast Name

Who will be receiving the mental health services?

Age of the Person Receiving Services (13 years and older)

Preferred Language

Other

Town / Municipality

Email Address

example@example.com

Phone Number (Optional but recommended)

Please enter a valid phone number.Format: (000) 000-0000.

What type of support are you interested in?

Have you previously received mental health support or therapy?

How soon would you like to be connected to a therapist?

Do you have reliable internet access for virtual sessions?

Is there anything else you would like us to know about your needs?