top of page

Detailed  Report  Form  

Please fill out the form below to communicate to us that someone you know is struggling.  (This person may be struggling with any range of issues and may just need some support and guidance, or they may have already taken steps to harm themselves or others and need more intense, immediate assistance.  Either way, they need help and we are here to provide that for them.)  The form is anonymous, but if you'd like to include your contact information so we can ask any pertinent follow-up questions, please do so.  

bottom of page