This form is not intended for urgent communication or crisis services. If you are experiencing an emergency, please contact 911 or visit your nearest emergency room.

We are an out-of-network provider and we do not accept insurance. By submitting this form, you understand that the initial contact does not constitute the initiation of a professional relationship. Although reasonable measures are taken to protect your information, the security of electronic communication cannot be guaranteed. You are strongly discouraged from including sensitive and/or detailed health information in this electronic form. By submitting this form, you acknowledge and accept the risks of transmitting your personal information via the internet and you agree to hold Virginia Behavioral Health harmless for the unauthorized access, disclosure, or use of any personal information you provide. By submitting this electronic form, you are indicating your agreement to these terms and conditions.

Below are some resources that may also be of help:

National Suicide Prevention Lifeline: 1-800-273-TALK

National Crisis Text Line: Text HOME to 741741

Postpartum Support International: Text HELP or Call 1-800-944-4773

Postpartum Support Virginia: 703-829-7152

LGBT National Hotline: 888-843-4564

Trans Lifeline (peer support):  877-565-8860