Connect with a Therapist
Through an expansive database of culturally-competent and patient-centered licensed mental health professionals, BMHA offers confidential referrals for those seeking mental health services.

For those seeking information or connection with a mental health professional please fill out the questionnaire below. All information is stored in our protected database, and is never sold to anyone for any reason.
Email *
Demographic Information
We want to learn a little more about you. All questions with an asterisk (*) are required.
First Name *
Last Name *
City *
State *
Zip Code *
Phone Number *
Preferred Method of Contact *
Are you requesting services for yourself or someone else? *
Have mental health services been provided recently? *
If yes, check all that apply
When were services provided?
Briefly describe the symptoms or presenting problem *
Please choose your insurance carrier. *
Therapist Preferences
Your answers to the questions below will help our team send a customized list of professionals who meet your needs. We will do our best to get your connected to the right person, but do not guarantee exact match.
Preferred Gender of Therapist *
Preferred number of Years in Practice
Preferred Sexuality of Therapist
Faith-Based approach of Therapist
Clear selection
I would like a therapist who offers Online/Teletherapy
Clear selection
Please provide any additional information that you believe will be helpful.
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This form was created inside of Black Mental Health Alliance for Education and Consultation, Inc.. Report Abuse