Boost! Screening Form

Boost!’s personalized quality of care model is unique in the mental health field. Our team works closely together for families so they can access everything they need in one space. No more running around to various professionals – Boost! will serve as your facilitator and coordinator – ensuring continuity, support and communication for your family.

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    Boost!U Intake Form Welcome to Boost!U

    It’s wonderful that you have taken the first step to get some help. How can we support you?

    Please tell us a bit more about you so that a Boost! Intake Coordinator can get back to you (within 2 hours)

      Your Date of Birth
      What would you most like help with?

      When are you most easily available?

      How do you prefer we work together?
      PhoneVideo Call
      Is there anything else you would like us to know before we speak?

      Boost!

      203-557-8444
      500 Post Rd E 2nd Floor Suite 230 Westport, CT 06880