If you are experiencing a mental health emergency, dial 911 or 988 immediately.

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We will respond to all requests within 72 hours.

〰️

If you are experiencing a mental health emergency, dial 911 or 988 immediately. 〰️ We will respond to all requests within 72 hours. 〰️

Verification by ID.me • What is ID.me?

Mental Health Assistance

First Response Wellness Foundation wants to help you ensure that you are with us for a long time and that you continue to provide for your community. We understand that the things you see are sometimes stressful.

Let us help you, we will pay for you to speak in person, with a mental health professional.

Please note: You can verify your first responder employment through paystubs or using ID.me at the bottom of this page. Please ensure you do the ID.me prior to completing the request for mental health assistance.

We will review your request and provide you with a response within 72 hours.

Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Email

Phone Number

This number must be able to receive text messages.

(###)

###

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State of Residency

Agency You Are Affiliated With

Title within Agency

Psychologist/Psychiatrist Name

Psychologist/Psychiatrist Phone Number

Please make sure this is a valid contact number for the mental health office.

(###)

###

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Acceptance of First Response Wellness Foundation policies and procedures.

By clicking this checkbox and submitting this form, you affirm that you have read and understand the policies surrounding funding of mental health/training by the First Response Wellness Foundation. You can view the organizations policies under "Public Documents" and select "Funding Request Information".

I have read and understand the policies set by the First Response Wellness Foundation and affirm that I am a first responder who is currently affiliated with a public safety entity.