How to initiate services with Here Now Health
Here Now Health offers several direct services, including virtual mental health therapy and caregiver support sessions. Additionally, our Care Advocate team works to connect youth with other care that meets their unique needs.
This form asks for basic information about the youth and their caregiver. By sharing this information, you will help us send the caregiver a referral with accurate details. Please complete the form to the best of your ability based on the information you have. Submit a separate form for each youth you are referring
DISCLAIMER: If you or someone you are assisting is in immediate danger of harming themselves or others, please call 911 or go to the nearest emergency room. This questionnaire is not monitored in real-time and is not intended for emergency situations. For urgent mental health support, you can also contact the Suicide & Crisis Lifeline by calling or texting 988 at any time. By checking this box, I attest that I have read and understand the above statement and will not expect emergency response from Here Now Health *