We are glad you are here. The Washington COVID-19 Mental Health Network helps connect Washington's frontline healthcare workers (doctors, nurses, nursing assistants, respiratory therapists, paramedics, EMT's etc) with no-fee, short term therapy by a licensed mental health therapist.
If you are interested in tele-therapy (therapy by phone or video) and are involved in providing healthcare related to COVID-19, fill out the form below. By return email, you will be sent the names of three participating licensed therapists, along with details for how to contact them.
We respect your privacy. When this form is submitted the data is NOT stored on the web server that hosts this website. Submitted data is transmitted securely to a secure email account that is used solely to match you with therapists. The information is only seen by a Washington licensed therapist. Your information will be stored for a maximum of 1 month.
Are you currently involved in providing healthcare related to COVID-19? (required)
What is your healthcare role? (nurse, doctor, EMT etc)
Would you prefer a male or a female therapist?
Anything you would like to tell us (not required)
The contents of this form will only be seen by a licensed clinician. All personal information is handled securely and in confidence. If you would prefer to request support via email, contact us at email@example.com.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service