Law Enforcement + First Responder Wellness Consultation Form

Ellie Mental Health’s Law Enforcement & First Responder Program partners with multiple law enforcement and first responder agencies to provide annual wellness consultations/check-ins. This service is funded by the department/agency and is meant to encourage employees to do more for themselves and feel supported in doing so.

Please complete the following consent form to get your appointment scheduled. If we have availability during one of the times you listed, you will receive an e-mail invite for your appointment. If we do not have availability, a member of the Law Enforcement & First Responder team will reach out to you by phone to find another time that works for you.

LEFT Wellness Consultation Referral & Consent Form

Ellie Mental Health’s Law Enforcement and First Responder Program partners with multiple law enforcement and first responder agencies to provide annual wellness consultations/check-ins. This service is funded by the department/agency and is meant to encourage employees to do more for themselves and feel supported in doing so.