top of page

Mental Health Assistance Request Form

If you are an individual or business seeking mental health services or financial assistance please fill out the form below. If you have any questions or concerns please give us a call at 435-256-3490 we would be happy to help. All requests are thoroughly reviewed and assistance is based on funds available.

How Can We Support You


Heber City, UT, 84032




Social Media

  • Facebook
  • Twitter
  • LinkedIn
  • Instagram

Thanks for submitting!

If you are requesting financial assistance for mental health services received please submit all receipts and proper identification to  

matt-artz-Fu2v5drnMBA-unsplash copy.jpg
If you need immediate mental health help, call the national suicide hotline: 1-800-273-8255
Join The Weekly Tough Conversation On Trauma 
bottom of page