Request a Presentation

To request a Wellmore presentation,
please complete and submit this form:

Name*

Title

Company

Address*

City*

State*

Zipcode*

Phone Number

Email*

How did you hear about us?

Who will be your audience?

Anticipated number of guests?

Do you have a specific date/time/location for the presentation?

I would like to request a presentation about the following program(s):

All ProgramsAdolescent Treatment Services (Ages12-20)Adult Intensive Outpatient Clinic ( AIOP)Care Coordination (CC)Community Case ManagementChild FirstChild Outpatient Services (COP)Child Victim ServicesCommunity Support for Families (CSF)Crisis Intervention Services (EMPS)Early Childhood Consultation Partnership (ECCP)Functional Family Therapy (FFT)Intensive In-Home Child and Adolescent Psychiatric Services (IICAPS)Intimate Partnet Violence - Family Assessment Intervention Response (IPV-FAIR)Morris Recovery House (MH)Multisystemic Therapy-Building Stronger Families (MST-BSF)Nurturing Families Network (NFN)Positive Parenting Program (Triple P)School PreventionSuboxone TreatmentSupportive Housing for FamiliesTherapeutic Shelter (TS)Transitional Case Management (TCM)Women and Children’s Program (WCP)

Other topic(s) you would like the presentation to include and your intended objective?

*required

You may also call 1-855-WELLMORE (1-855-935-5667) to request a presentation

or contact Jackie Post at (203) 574-9000 x1109

or print and mail this request to:

Wellmore
Attn: Community Relations
141 East Main Street
Waterbury, CT 06702