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Initiate Services

~4 mins left

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 patients with urgent or ongoing physical healthcare, specialty services, and other care that meets their unique needs.

This form will ask you a few questions about the youth and their caregiver. By submitting this form, you will enable us to send that caregiver a referral with the most accurate information about the youth in their care. You may have the most accurate information about the youth, so please complete this form to the best of your ability and current capacity.

Please complete this form once per youth; do not include information for multiple youth in a single submission. If you would like to initiate services for more than one youth, please complete this form once for each.

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 *