More Than Basic Therapy Group Interest Form
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If you are having thoughts of harming yourself or others please immediately call 911 to seek help from your local mental health authorities. You may also reach out to the following for 24-hour help.

Crisis Text Line
Text 741741

National Suicide Prevention Lifeline
1-800-273-TALK (8255) 
Guardian Name *
Child's Name *
Child's Age *
Email Address *
Best Contact Number *
Area of Highest Concern *
Thank you for submitting your inquiry, in the next 24-48hrs you will receive an email to schedule your free consultation.
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