Mental Health Form - Jewish Family & Community Services East Bay

Do you have Medi-Cal coverage?

Yes. Alameda County.
Yes. Contra Costa County.
No
Unsure

Your date of birth

What services are you looking for?

Individual Therapy (Child/Youth)
Individual Therapy for Adult (Jewish Community Member)
Individual Therapy for Adult (Refugee)
Family Therapy
Parenting Support: Group or Individual
General Clinical Assessment for Treatment Recommendations

Name

First

Last

Email

Phone

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