Treatment Center interest form

CCAMH offers evidence-based youth mental health treatment on a sliding scale ($50 - $225 per session). In-person treatment is offered in San Luis Obispo and Santa Cruz counties and via Telehealth for families unable to attend in person. We will do a complete assessment to determine the best course of treatment and use evidence-based treatments that show the most promise for treating the specific condition your child or teen may be suffering.

Please fill out the form below, and we will get back to you within 48 hours. Your answers and identity will be kept confidential.

Your Name

First Name

Last Name

Your Child's Name

First Name

Last Name

Please share your child's age, grade in school, and any hobbies and interests.

Your Email

Best phone number to reach you

(###)

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Please tell us why you are seeking therapy for your child and/or family.

Please use this space for questions or additional information you'd like to share.

Optional

Treatment Center Location

San Luis Obispo

Soquel (Santa Cruz)

Other

Treatment Center Interest Form

Our mission is to expand access to quality, evidence-based youth mental health care as quickly as possible.