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Apply for Mental Health Services

Part 1: Complete the following form to request free counseling services.

Request Services:

First and Last Name

Email

Phone

Address

Total Family Income Level:

$0-40,000

40,000-$75,000

$75,000+

What are you interested in?

Children's Therapy

Adolescent/Teen Therapy

Parenting/Family Therapy

How many people live in your household?

0-1

2-3

4-5

6 or more people

Give a brief description of your concerns:

Is there more than one parent or caregiver in the household?

Race and Ethnicity

Thanks for applying! In order to be considered for services, you must also complete the following forms and submit to Info@headfirstmentalhealthinitiative.com

ACES Questionnaire

HMHI Application Questionnaire- Mental Health Services

Conveniently located in the Oak Lawn neighborhood of Dallas, TX.

Direct email for information:

info@headfirstmentalhealthinitiative.com

Need More Information?

Contact Us Now:

Thanks for submitting!

Part 2: Complete the following questionnaires and submit to info@headfirstmentalhealthinitiative.com

ACES Questionnaire

Application for Services- Mental Health

Email: info@headfirstdallas.com

© 2022 by the HeadFirst Mental Health Initiative

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