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Care Connections™ Support Request
A Mindful Resource Inc. connects individuals and families with trusted mental wellness resources across Dallas–Fort Worth.
Name
*
Email
*
Phone
*
Zip Code
*
What Support Are You Looking For?
*
What Support Are You Looking For?
• Individual therapy
• Couples counseling
• Family counseling
• Youth therapy
• Men’s mental health
• Trauma support
• Anxiety / depression support
• Grief support
• Substance use support
• General mental wellness resources
OTHER
if OTHER please explain
Preferred appointment format
*
Preferred appointment format
• In-person
• Telehealth
• Either
Insurance or Payment
*
Insurance or Payment
• Private insurance
• Medicaid
• Self pay
• Sliding scale needed
• Unsure
Tell us anything else that would help us connect you with the right support.
Consent
*
Consent
I understand this is not crisis support and that A Mindful Resource Inc. will help connect me to resources.
Submit
