IF THERE IS A MENTAL HEALTH EMERGENCY PLEASE CALL 9-1-1 OR GO THE NEAREST EMERGENCY ROOM

By submitting this form via this web portal, you acknowledge and understand that this is an unencrypted electronic messaging and wish to continue. By clicking "Yes, I agree to submit this form" you agree to hold Thrive Haven harmless for any unauthorized use, disclosure, or access of your protected health information sent via this form.