®

MENTAL HEALTH AMERICA
OF FRANKLIN COUNTY
538 E. Town St., Suite D
Columbus, OH 43215
614-221-1441

For more information on ParenTalk, or to become a ParenTalk corporate client, please fill out this form and click the "Submit" button below. You may also fill out this form and click the "Print" button below and mail it to the above address or fax it to (614) 221-1491.

Your Name:
Title:
Company:
Street Address:
City:
State:
Zip:
Phone #:
Fax #:
Email:
Number of Employees:
I would like more information on becoming a ParenTalk corporate client.