HHSA Behavioral Health Services (BHS) Community Request Form

HHSA Behavioral Health Services (BHS) Community Request Form

This online form can be used in three ways:

Request a behavioral health professional to participate in a resource event (tabling), OR
Request a behavioral health, mental health, or substance use-related presentation for my group or organization, OR
Request materials/resources from BHS for your team or organization to share with the community at an upcoming activity.

STEPS TO SUBMIT A REQUEST:

To submit a request, please complete the Contact Information fields below and select your Request Type from the drop-down menu.

Upon selection from the drop-down menu, additional fields for your request will appear for you to complete. Please complete these fields to provide BHS with details specific for your activity (e.g., time frame needed).

Please submit requests at least two weeks in advance to allow our team sufficient time to complete your request. Once submitted, you will receive a confirmation email and will be connected with a liaison within 3-5 business days.

To accommodate requests, BHS may identify a department representative, staff from another HHSA or County team, and/or a community contractor or partner. In the event resources to address an initial request are unavailable, the department will provide any available options aligned to the original inquiry received for consideration.

If you need to follow-up with BHS regarding your request, you may email Engage.BHS@sdcounty.ca.gov.

*Please submit ONE request at a time*

Contact Information

Contact Name*

Contact Email*

Contact Phone Number*

Phone

Affiliation*

Select

Organization/Group*

Request Type*

Select

Resource Event Participation Request

Presentation Request

Materials & Resources Request

Acknowledgement*

I acknowledge that I am submitting this form at least two weeks before the presentation/event date, to allow BHS sufficient time to complete my request.

Please note that if a submission is sent less than two weeks in advance, we may not be able to accommodate the request fully.

Event/Presentation Name*

Health Issue or Topic*

Select

Please describe the topic*

Purpose for Event/Presentation*

Event Date*

For Materials/Resources Requests: Please indicate when you need the resources by.

Event Time*

Event Location*

Zip Code*

Anticipated Number of Attendees*

Focus Population*

Select

Please describe the focus population

Language Needs*

Select

Please specify what language(s)

Would you like BHS to provide printed resources?

Select

FOR INTERNAL BHS STAFF ONLY : Tabling Materials

If you are BHS Staff please indicate if you need to borrow any tabling materials (e.g., table cloths, documents holders, etc.) or if you would like to request swag items for your event. Please include the amount you need for any items requested.

Accompanying Material(s)

Please ensure that any event or promotional materials attached are available in at least both ENGLISH AND SPANISH.

Drag and drop files here or

Additional Information

Please provide any additional comments or details about your request that were not covered by previous questions (e.g., presentation length).

Send me a copy of my responses

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