Parent Contact Information for UMCH Family Services

Thank you for your interest in UMCH Family Services. For more information, please call, mail or email us at the addresses below.

Send us a message.

"*" indicates required fields

Referred Client*

First Last

Date of Birth*

Contact Name (Parent/Guardian/Caregiver)

First Last

Contact Phone*

Is it OK to leave a message or text message?

Yes

Contact Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Service Request (check all that apply)

Home-Based Therapy

Psychiatry/Medication Evaluation

Outpatient (office/telehealth)

Name of School

Referral Contact Name

Phone

How did you hear about UMCH Family Services?

(614) 885-4058

Additional Service Locations: