A simple place to start

Tell us what kind of support you're looking for.

Complete this for yourself, or as a parent, legal guardian, or authorized representative. Thryve will review what you share and help route you toward appropriate support through our clinical and community partners. Expect to hear from a Thryve representative within 24 hours.

For yourself or someone you are authorized to represent. Expect a response within 24 hours.

Start request

Tell us how we can help

Start with what you know.

Required questions are marked. Everything else can be completed only when it is known and comfortable to share.

Privacy and secure submissionShare only what is needed to help us respond. Information submitted through this form is transmitted securely and used to review your request and coordinate an appropriate next step.

Request detailsStep 1 of 6

Who are you completing this for?Choose the option that best describes you.

MyselfI am looking for support for myself.My child or someone I am legal guardian forI am their parent or legal guardian.Someone I am authorized to representI am authorized to complete this request for them.

About the personBasic information about the person looking for support.

First nameLast nameDate of birthGenderMarital status

Best contact informationShare the best way for us to follow up.

PhoneEmailStreet addressCityStateZIP code

Insurance coverageShare this only when it is available.

Primary insurance

Insurance providerMember ID

Secondary insurance

Insurance providerMember ID

What support would help?Share what you know. A complete clinical history is not expected here.

What would you like help navigating?Select all that apply. This helps us understand where to begin and does not promise a specific service or placement.

PsychiatryTherapyCase routing and managementOther

Significant medical eventsFor example: a recent hospitalization, surgery, or major illness.Currently taking psychiatric medication?Is the person having thoughts of self-harm or suicide?Additional safety informationPrimary concern or diagnosisAnything else you would like us to know?

Emergency contactThis optional section can identify another person connected to them.

Contact nameContact phoneRelationship

I confirm that I am completing this for myself or am authorized as a parent, legal guardian, or representative to complete it for someone else. I understand that this form is not monitored as an emergency or crisis service.

Nothing is sent until you review the request and complete the security check.

Prefer to speak with someone?

You can start by phone.

Call Thryve during regular business hours and a team member can help guide the conversation.

Call 718-587-1555

PrivacyYour information is treated with care.

Please share only information needed for this request. Thryve uses what you submit to respond and help coordinate appropriate support. Submitting this form is not consent to treatment and does not establish a provider-patient relationship. For privacy questions, contact info@thryveny.com.

Urgent helpThis form is not an emergency or crisis service.

This form is not monitored continuously. If you or someone else is in immediate danger or needs urgent medical attention, call 911. For immediate emotional or crisis support in the United States, call or text 988.

Call or text 988 Call 911