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Patient Forms

NEW ADULT CLIENT FORMS

 Adult Questionnaire
 Adult Questionnaire (Español)

NEW CHILD CLIENT FORMS

 Child Questionnaire
 Child Questionnaire (Español)

Links & Resources

Mental Health Council of Arkansas

Disability Rights Center 
800.482.1174

www.webmd.com

National Alliance on Mental Illness (NAMI) 
800/950-6264
Support groups for families of adults with serious mental illness, information about medications (fact sheets prescription assistance programs), listing of state affiliates, Family to Family Education program in some areas

National Institute of Mental Health (NIMH) 
866/615-6464 (Info. Center)

Association for Retarded Citizens (ARC)
800/433-5255

Federation of Families for Children’s Mental Health 
703/684-7710
Parent support and advocacy organization; listing of local and state support groups on website.

National Domestic Violence Hotline
800/799-7233 
800/787-3224 (TTY)

Mental Health Radio bit (mp3)

TREATMENT INFORMATION

American Psychological Association (APA) 
800-964-2000

American Psychiatric Association (APA) 
888-357-7924 (speak with Answer Center Coordinator)

American Academy of Child and Adolescent Psychiatry
Fact sheets and psychiatrist referrals available online using website; no information available by phone

SAMHSA’s National Information Center
800/789-2647
Referrals to wide range of mental health treatment facilities including those offering sliding scale fees. Referrals to inpatient, outpatient, residential, etc. Search using Mental Health Facilities option.

National Clearinghouse on Alcohol & Drug Info
800/729-6686 
Substance Abuse Mental Health Services Administration Facility Locator. Referrals to alcohol/substance abuse and dual diagnosis programs –inpatient, outpatient, residential. Both public and private program information is available.

CHILDREN’S MENTAL HEALTH

Federation of Families for Children’s Mental Health 
703/684-7710
Strong parent support and advocacy network for parents of children with mental health problems Search online for state and local support groups.

American Academy of Child and Adolescent Psychiatry
Fact sheets and psychiatrist referrals available online using website; no information available by phone

Child and Adolescent Bipolar Foundation
Support group for parents. Some groups are online only; some hold meetings. Support group information is listed on website. Has treatment referrals on website.

Children and Adults With Attention Deficit/Hyperactivity Disorder (CHADD)
800/233-4050

Information for both children and adults with ADD/ADHD. Support groups.

INFORMATION/SUPPORT GROUPS/REFERRAL

ALCOHOL/SUBSTANCE ABUSE/DUAL DIAGNOSIS

Dual Recovery Anonymous
877/883-2332
12 step program support groups for dual diagnosis (mental illness and alcohol or substance abuse)

Alcoholics Anonymous (central offices, intergroups, and answering services)
12 step program support groups

Al-anon/Alateen 
888/425-2666
12 step support group program for spouses/significant others, teens affected by the alcoholism of a family member

ANXIETY DISORDERS

Anxiety Disorders Association of America 
240/485-1001
Referrals to support groups & literature. Medication and treatment information in Resources section (dropdown menu from tab near top of the page)

Freedom From Fear (FFF) 
718/351-1717
Information about anxiety and depression.

ATTENTION DEFICIT/HYPERACTIVITY DISORDER/ATTENTION DEFICIT DISORDER

Children and Adults With Attention Deficit/Hyperactivity Disorder (CHADD)
800/233-4050 
Referrals to support groups, information about ADD and ADHD

Attention Deficit Disorder Association (ADDA) 
Referrals to support groups for adults with ADD. Information regarding ADD and ADHD for both adults and children. Treatment referrals.

BIPOLAR/DEPRESSION

Depression and Bipolar Support Alliance (DBSA)
800/826-3632
Referrals to support groups. Extensive information on depression and bipolar disorder. New bipolar disorder toolkit available at no cost. Patient to Patient therapist recommendation section.

NARSAD: Mental Health Research Association
800/829-8289
Referrals to support groups. Downloadable pamphlets on depression, schizophrenia, and antipsychotic medications.

Family Mental Health Foundation 
877-773-4673
Has a 224-hour helpline; information about postpartum depression including Answers to Frequently Asked Questions, personal stories, list of books on this topic; on-line screening questionnaire; and links to other Resources.

Postpartum Support International
Information about postpartum depression as well as during pregnancy; list of state support coordinators is available on web site. Through the coordinators can get names of mental health professionals with expertise in working with reproductive related mood disorders.

Families for Depression Awareness
Support organization to help family members understand depression and bipolar depression. Have a pamphlet “Helping a Family Member who is Depressed”. Expert and family profiles for all ages including adolescents and children.

BORDERLINE PERSONALITY DISORDER

Treatment and Research Advancements National Association for Personality Disorder 
888/482-7227
Offers information about borderline personality disorder for both individuals and their families, information about dialectical behavior therapy (DBT), guidelines for choosing a therapist and treatment referrals. Has list of books, links to other resources, educational program for family members, and some support groups.

Borderline Personality Resource Center 
1-888-694-2273
Offers information about borderline personality disorder and resources for both individuals and their families.

CHILD ABUSE/SEXUAL ABUSE

Girls and Boys Town USA 
800/448-3000 
24 hour hotline

Child-Help USA
800/422-4453 
Assists both child and adult survivors of abuse, including sexual abuse. Is a 24 hour hotline staffed by mental health professionals.

Victims of Incest Can Emerge Survivors (VOICES) 
800/786-4238

Rape, Abuse, and Incest National Network (RAINN) 
800/656-4673 
Toll free line connects callers with local crisis counseling center that focuses on sexual assault/sexual abuse counseling. Local crisis center information can be found on website.

National Clearinghouse on Child Abuse & Neglect (NCCANCH)
800/394-3366 
Resource for professionals seeking information, statistics, etc. on this issue.

EATING DISORDERS

National Eating Disorders Organization 
800-931-2237 
Provides treatment referrals and other information on eating disorders.

National Association of Anorexia Nervosa and Associated Disorders (ANAD)
847/831-3438

POST TRAUMATIC STRESS DISORDER

PTSD Alliance Resource Center 
877/507-PTSD (7873)

Post Traumatic Stress Disorder
Overview from onlinecounselingdegrees.net

International Society for Traumatic Stress Studies 
847/480-9028

SCHIZOPHRENIA

National Schizophrenia Foundation/Schizophrenics Anonymous 
Information about schizophrenia and referrals to Schizophrenics Anonymous support groups.

NARSAD: The Mental Health Research Association
800/829-8289
Information center. Downloadable brochures on schizophrenia, depression, and anti-psychotic medications.