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BWC Behavioral Health Request for Services Form

BWC Behavioral Health - Request for Services

To request services through our Behavioral Health Department, please fill out the form below and somebody from our team will respond within three business days. Our Behavioral Health Department provides services to individuals, age 6+, with full scope Medi-Cal insurance coverage, or in some cases, without any insurance coverage.  

If you are having a medical or psychiatric emergency call 911 or go to the nearest hospital emergency room.

Services Requested
Are you interested in LGBTQ+ specific supports & services?
Insurance Information
ZIP