Apply for DMH child, youth, and family services

This page will guide you through the process of applying for DMH services
Within seven (7) days of receipt of a Request for Child, Youth, and Family Services application, DMH will contact the applicant or guardian by telephone.

DMH Application Questions

The Details of Apply for DMH child, youth, and family services

What you need for Apply for DMH child, youth, and family services

Applications for youth under the age of 18 who request mental health services must include the following completed forms, with parent or legal guardian signatures and dates where indicated. Applications are available to download and print at the top of this page.

 

  •         Request for Child/Adolescent Services application
  •         DMH Service Authorization Determination (page 6 of the application form)
  •         Authorization(s) for Release of Information

 

To expedite the determination, DMH encourages applicants to also submit relevant medical and educational information and documents such as:

 

  •         Psychiatric assessment completed by a licensed clinician within the previous six months, and/or
  •         Hospital admission/discharge reports if hospitalized during the previous six months
  •         Copy of the Individualized Educational Plan (IEP) if one is in place

 

While submitting medical and educational information at the time of a request for services is not required, it is strongly recommended the information be submitted at the same time.  DMH will need to review such information and will require such information at a later date.

How to apply Apply for DMH child, youth, and family services

Applications must be submitted to the office that corresponds to your city or town (see the chart below). If you're not sure where to submit your application, find your town on this page and you will be directed to the corresponding area office. 

Office

Mailing Address

Phone Number

Boston

85 East Newton Street, Boston, MA 02118

(617) 626-9200

Brockton

165 Quincy Street, Brockton, MA 02302

(508) 897-2000

Northampton

1 Prince Street, Northampton, MA 01060

(413) 587-6200

Tewksbury

P.O. Box 387, Tewksbury, MA 01876-0387

(978) 863-5000

Worcester

361 Plantation Street, Worcester, MA 01605

(774) 420-3140

You can apply in person at your nearest DMH site office. To find the office that serves your community, you can search and click your town on our alphabetic index

To apply by fax, print and complete the following forms:

  •         Request for Child/Adolescent Services.
  •         DMH Service Authorization Determination
  •         Authorization(s) for Release of Information 

When you have completed and signed the forms above, find your city or town on the alphabetic list, and fax your application to the fax number for the respective DMH Office in the list below. Please call the phone number listed if you have any questions.

Office

Mailing Address

Phone Number

Fax Number

Boston

85 East Newton Street, Boston, MA 02118

(617) 626-9200

(617) 626-9216

Brockton

165 Quincy Street, Brockton, MA 02302

(508) 897-2000

(508) 897-2047

Northampton

1 Prince Street, Northampton, MA 01060

(413) 587-6200

(413) 587-6240

Tewksbury

P.O. Box 387, Tewksbury, MA 01876-0387

(978) 863-5000

(978) 863-5091

Worcester

361 Plantation St. Worcester, MA 01605

(774) 420-3140

(774) 420-3165

Next steps for Apply for DMH child, youth, and family services

What to Expect After You Submit Your Application?

Within seven (7) days of receipt of a Request for Child/Adolescent Services application, DMH will contact the applicant or guardian by telephone.  The purpose of the phone contact will be to:

  • Acknowledge DMH’s receipt of the Request for Child/Adolescent Services application,
  • Review the determination process,
  • Confirm the applicant or guardian wants to continue the determination process,
  • Assess the applicant’s immediate or emerging needs and respond as appropriate, and
  • Initiate the collection of relevant medical and other information that supports the applicant’s request for services.

Request for Child/Adolescent Services Application Forms

Contact for Apply for DMH child, youth, and family services

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