AR ConnectNow Care Guide Request Form

Want to speak with someone that can help you find the type of mental health services or resources you are looking for? Speak with an AR ConnectNow Care Guide.

This form should only be used to request information about AR ConnectNow Care Guides. If this is a medical emergency, call 911 or go to your nearest emergency room.

First Name

Last Name

Phone Number

Email Address

Preferred Contact Method:

Phone Call

Text (SMS)

What kind of information are you looking for?

Finding mental health or substance abuse treatment

Getting telehealth mental health services through AR ConnectNow

Food Assistance

Clothing Assistance

Utility Assistance

Emergency Housing

Other healthcare treatment options

Prescription Assistance

Other

Please describe

Who are you looking for information for?

Myself

My Child

How old is your child?

Other

Please describe

Is there other information you can provide that would help us meet your needs?

County

Please describe