Applications for DMH Services

Applications and forms for DMH services.

Most mental health services, including medication and therapy are provided through health insurance – MassHealth (Medicaid), the Massachusetts Health Connector (health insurance marketplace) or through private insurance (employer-based). The Department of Mental Health (DMH) provides supplemental services for children, youth and adults with the most serious mental health needs.

For additional resources and information about Mental Health Services in Massachusetts, visit our Mental Health Resources page.

Contact Info - Where to Submit Your DMH Application

Not sure which office covers your town? Find it here.  Contact your office using the contact information below with questions about the DMH application process. Submit applications using DMH Secure Email.

Office	Mailing Address	Phone Number	Fax Number	E-mail Address
Boston	85 East Newton Street Boston, MA 02118	[phone]	[phone]	[e-mail]
Brockton	165 Quincy Street, Brockton, MA 02302	[phone]	[phone]	[e-mail]
Northampton	1 Prince Street Northampton, MA 01060	[phone]	[phone]	[e-mail]
Tewksbury	P.O. Box 387 Tewksbury, MA 01876-0387	[phone]	[phone]	Under 18:  [e-mail] 18 & Older: [e-mail]
Worcester	361 Plantation Street Worcester, MA 01605	[phone]	[phone]	[e-mail]

Find which DMH Office covers your town  Submit a Completed Application Using DMH Secure Email 

Fillable Application for DMH Services - can be submitted electronically

This fillable application can be completed and submitted via email without printing or scanning. Email the completed application and related forms to the office covering your town on the table above.

Please note: In order to complete this process, hand-signed authorization(s) to release information will be needed to receive information from the applicant's healthcare/education providers. DMH can provide assistance to individuals unable to print, sign, and scan hand-signed Releases of Information.

• Download the application. 

Submit this application using DMH Secure Email

Download the fillable application  Submit Via DMH Secure Email 

Printable applications for DMH Services

These applications can be printed, completed, scanned, and emailed or faxed office covering your town on the table above.

• Application for DMH Mental Health Services (English)
• (Fillable PDF) Authorization for Release of Information - Two Way
• Application for DMH Mental Health Services (Español)
• Application for DMH Mental Health Services (Portuguese)
• Application for DMH Mental Health Services (Cape Verdean Creole)
• Application for DMH Mental Health Services (Chinese- Traditional)
• Application for DMH Mental Health Services (Chinese- Simplified)
• Application for DMH Mental Health Services (French)
• Application for DMH Mental Health Services (Vietnamese)
• Application for DMH Mental Health Services (Khmer)
• Application for DMH Mental Health Services (Russian)
• Application for DMH Mental Health Services (Haitian Creole) 
• Application for DMH Mental Health Services (Arabic) 

Eligibility Information

Most mental health services, including medication and therapy are provided through health insurance – MassHealth (Medicaid), the Massachusetts Health Connector (health insurance marketplace) or through private insurance (employer-based).  The Department of Mental Health (DMH) has a specialized role in the healthcare delivery system.  DMH provides supplemental services for people with the most serious needs.  These services are beyond those supplied through health insurance and require approval by DMH. Learn more about DMH eligibility.

Learn about DMH eligibility 

Massachusetts Behavioral Health Help Line

For 24/7 Supports, please call or text 833-773-2445. You can also visit https://www.masshelpline.com/ to live chat. This line is for crisis supports as well as resource and mental health service inquiries.