Emergency Contact Numbers:

911 • 211 for the local Crisis Center • Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Disaster Distress Helpline: 1-800-985-5990 or text TalkWithUs to 66746. (TTY 1-800-846-8517)

Click here for additional emergency resources

Your request is very important to us. If you are interested in services, please answer the following questions and someone will respond as soon as possible.

If you are trying to schedule an appointment, all fields must be completed.

Please note that BMH does not prescribe nor dispense psychotropic medications.

If you encounter any issues with the form, please call our office at (813) 315-8648 for assistance.


Telehealth is NOT the best option for you if you can answer yes to any of the following:
• You have thoughts of hurting yourself or others
• You are a minor or you are under the care of a legal guardian
• You are in an urgent crisis or an emergency situation
• You have been diagnosed with a severe mental illness, or if you have been advised to be in psychological supervision or psychiatric care
• You were required to undergo therapy or counseling either by a court order or by any other authority
• You do not have a device that can connect to the Internet or you do not have a reliable Internet connection

If you have insurance, please provide a copy of your insurance card here.