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The Well: Family Support

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Reason for care

Select date & time

1 Appointment info

2 Prescreener

Reason for care

3 Contact information

What is the primary reason for seeking care?

(Select all that apply.)

Anxiety Attention or concentration difficulties Behavioral or emotional concerns (child or adolescent) Depression or mood concerns Grief or loss Relationship concerns (couples, family, or interpersonal) Substance use or recovery support Trauma or stress-related concerns Perinatal or postpartum mental health Parenting stress or support needs Life transitions or adjustment concerns Other

What kind of care is being sought?

What mental health concerns or treatment have occurred in the past?

Select all that apply.

In therapy now In therapy in the past Taking psychiatric medication now Taken psychiatric medication in the past Hospitalized for mental health reasons now or recently Hospitalized for mental health reasons in the past Known neurologic or genetic disorder Attempted suicide in the past None of these apply

How can we help?

Clients/guardians: Briefly describe concerns or questions. Referring professionals: Include referral information.

Limited to 600 characters

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

Barksdale Missions, LLC.

662.368.2008 |

Columbus, MS

No Surprises Act

You have the right to receive a Good Faith Estimate of what your services may cost.

Main Location

617 18th Ave N
Columbus, MS 39701-2237

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THE CLIENT PORTAL IS NOT TO BE USED FOR EMERGENCY SITUATIONS. IF YOU OR OTHERS ARE IN IMMEDIATE DANGER OR EXPERIENCING A MEDICAL EMERGENCY, CALL 911 IMMEDIATELY.