Appointment Request Form
Please review the information and complete the brief form below. We will be in touch with you within 3-5 business days. We look forward to connecting with and assisting you!

*If you are currently experiencing an emergency please call 911 immediately or go to your nearest emergency room.

Free Telemental Health Services
Your health and wellbeing are a priority. Most people are finding these unpresidented times challenging. We want to ensure the physical health and safety as well as emotional health and safety of the Inland Empire community. In response to the pandemic crisis, new and returning consumers are now able to access counseling services electronically. We are proud to announce that Riverside Free Clinic is now offering free Telemental Health Services.

How Does it Work?
Telemental Health Services at Riverside Free Clinic are offered by University of Redlands students studying Clinical Mental Health Counseling under the training and supervision of faculty in the Department of Counseling and Human Services.

What Does it Cost ?
All services are free of charge.

When Are Services Offered?
Every Wednesday, your provider will be available by video or phone at a specified time between 5PM and 9PM.

In the meantime, if you find yourself or someone you know in crisis during this time please call the National Suicide Prevention Lifeline at 1-800-273-8255

What to Expect?
Your email will be used for the purposes of contacting you in order to set up services. Please be aware that we will not share your email with other agencies; however, we cannot guarantee the privacy of who has access to emails on your end. Emails are not considered to be confidential.

During the period of time that the clinic is closed, wellness checks will be conducted over a secure phone line/server.

By typing your name below, you are authorizing a mental health professional/trainee/student to contact you to initiate services during clinic closure.

Name:
Today's Date:
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Are you a new or returning client?
Clear selection
If you are a returning client, how long has it been since you last saw a counselor?
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Briefly describe what you are seeking counseling for and how you are hoping counseling will be helpful.
If you are experiencing any of the following symptoms please check all that apply
Email: *
Phone number:
Phone number: *
Is it ok to leave a voicemail?
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