Help Form

MAMH will assist (at no charge) individuals and families in accessing mental health treatment and other services such as housing, health insurance, public assistance, or educational assistance.

We are not clinicians, nor do we operate any programs for individuals with mental illnesses. We can only assist in helping you to access whatever service(s) you are seeking.

If you are interested in our help, please submit this form or contact:

Tim O'Leary
MAMH
130 Bowdoin St., Suite 309
Fax 617-742-1187
Email: Tim O' Leary

First Name:

Last Name:

Street:

City:

State:

Zip Code:

Email Address:

Telephone:

Fax:

Preferred Method of Contact:

Phone
Email
Fax
Mail

Are you requesting assistance for yourself or for another person? :

For myself
For someone else

Is the person needing assistance an adult (18 or over) or a child/adolescent? :

Adult
Child/Adolescent

Please briefly outline the assistance that is being requested:

Captcha Image (Security Code):

site map | privacy policy