Mental Health Support Request Form

Are you a front-line worker in the Indigenous sector in Montreal?

The NETWORK is able to connect you with various types of mental health services and cover the initial ten sessions of therapy.

Please fill out this short form so we can match you with the most relevant support.

 

Information:

 

GENERAL INFORMATION

Indicating that you are a non-Indigenous person will not impact your eligibility to receive mental health support for frontline workers.
A frontline program or organization directly assists community members.

 

THERAPY PREFERENCES

We will use this information to match you with the most relevant person to support you.

 

Please indicate your level of preferences for the following types of mental health support options 

Please note that Elder support is available for Indigenous Individuals only
Currently, we can only cover up to 10 sessions per individual. Prolongations are possible depending on available budgets and the influx of requests.
Examples may include: Burnout, stress, anxiety, traumatic event, grief, isolation, etc

 

Please select your availabilities