New Client Request Form

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Thank you for reaching out to The Brave Fight! Please fill out the form below to help us understand your needs and to get you set up in our system so that we can serve you more efficiently. This will allow us to contact you promptly and ensure that we provide you with the personalized care you deserve. Your privacy is important to us, and all information shared will be kept confidential. Please allow 24 business hours for a Brave Fight team member to reach out to you. If you are in need of more urgent help please text 817-381-6991. If you or someone you know are experiencing a mental health emergency please call 988 or go to your nearest emergency room.

Email *

First and last name *

Mobile phone number *

Prefered methods of contact (Check all that apply) *

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Who referred you to us?

Are you a Veteran, First Responder, or Family Member? (Check all that apply)

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First Responder PD

First Responder FD

First Responder EMS

Telecommunications (Dispatch)

Frontline Medical Worker

Family of First Responder

Family of Veteran

Other:

Please select the options that best fits your needs.

Trauma

Grief

Stress

Anxiety

Depression

Relationship Issues

Other

Please share any other information that would help us to serve you better.

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