Need Help - Mental Health America Boone County

Contact Us for Help or Support

We would love to hear from you. Please let us know how we can help. 765-482-3020 X100.
FOR AN EMERGENCY, CALL 911.

Domestic Violence: Get Help

PLEASE NOTE: WHILE WE WILL RESPOND AS PROMPTLY AS POSSIBLE, FILLING OUT THIS FORM WILL NOT GUARANTEE AN IMMEDIATE RESPONSE. IF YOU ARE IN IMMEDIATE DANGER, PLEASE CALL 911!

Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Safe Phone Number
Safe Email Address
Preferred Contact Method
Based on your selection, we will ask for a specific date and time to contact you or to schedule your Meet in Person or Virtually Meeting.
Phone Safe Time*
Please provide a safe date and time to contact you by phone.
Email Safe Time*
Please provide a safe date and time to contact you by email.
Meet in Person*
Please choose a time to meet in person (offices located at 1122 N. Lebanon St., Lebanon, IN). You may choose Monday through Friday 9:00 AM - 4:00 PM. Please note: We will make a staff member available to meet with you and you do not need to communicate with us any further. Just show up.
Virtual Meeting Time*
Please choose a time for your virtual meeting via Zoom (we would need to email a link to you) at your convenience. You may choose Monday through Friday 9:00 AM - 4:00 PM. Please note: We will make a staff member available to meet with you and you do not need to communicate with us any further. Just show up.
What do you need help with?
To select more than one choice on a computer, hold shift and click on the multiple choices. To select more than one choice on a mobile device, tap in field entry and make selections.
Additional information
If you would like to share anything else, please do so here.
Name
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