Thank you for making us your trusted partner on your mental wellness journey! Please complete this form in its entirety. Upon receipt, we will call or text you to confirm we’ve created a client portal, and you will receive an email invitation to set up your portal. In your portal, please complete all the intake forms (consents, assessment(s) and biography). When your intake packet is complete, we will be in touch as soon possible to schedule you with a clinician.

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(if client is younger than 18)
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Please note how many people live in your current household
This information is kept confidential and does not influence your ability to seek services or use insurance. This information is gathered for the purpose of client's needing financial support for services and/or grant funding as a not-for-profit agency.

Insurance OR Payment

YFC will check your benefits.
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Is there anything else you would like us to know about why you're seeking services for yourself/child?