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Mental Health Assistance

Pablo Leaños
Director of Mental Health Services

Heidi Perez
Administrative Secretary

*MENTAL HEALTH REQUEST FORM

[email protected]

English

Spanish

MENTAL HEALTH REQUEST

Please fill in this confidential form.
*MENTAL HEALTH REQUEST FORM

A staff member will reach out to you

using your preferred contact method.

Are you or someone else feeling suicidal?
Please call a suicide hotline immediately.

**IF THIS IS AN EMERGENCY,
PLEASE CALL 911 IMMEDIATELY**

CALIFORNIA YOUTH CRISIS LINE
www.youthcrisisline.org
1.800.843.5200 - 24 Hours / Bilingual

LOS ANGELES COUNTY
DEPARTMENT OF MENTAL HEALTH
dmh.lacounty.gov
1.800.854.7771 - 24 Hours / Bilingual

SOLICITUD DE SALUD MENTAL

Por favor complete este formulario confidencial.
*MENTAL HEALTH REQUEST FORM

Un miembro del personal se comunicará con

usted mediante su método de contacto preferido.

¿Usted o alguien más está pensando cometer suicidio Llame a una línea directa de suicidio inmediatamente.

**SI SE TRATA DE UNA EMERGENCIA,
LLAME AL 911 DE INMEDIATO** 

 LÍNEA DE CRISIS JUVENIL DE CALIFORNIA
www.youthcrisisline.org
1.800.843.5200 - 24 Hours/Horas - Bilingual

DEPARTAMENTO DE SALUD
MENTAL DEL CONDADO DE LOS ÁNGELES
dmh.lacounty.gov
1.800.854.7771 - 24 Hours/Horas - Bilingual