Teletherapy Client Intake Form

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    Crisis Help Resources


    Emergency: 911
    National Domestic Violence Hotline: 1- 800-799-7233
    National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
    National Network: 1-800-SUICIDE (800-784-2433)
    Crisis Text Line: Text “DESERVE” TO 741-741
    Lifeline Crisis Chat (Online live messaging):https://suicidepreventionlifeline.org/chat/
    Self-Harm Hotline: 1-800-DONT CUT (1-800-366-8288)
    Family Violence Helpline: 1-800-996-6228
    Planned Parenthood Hotline: 1-800-230-PLAN (7526)
    American Association of Poison Control Centers: 1-800-222-1222
    National Council on Alcoholism & Drug Dependency Hope Line: 1-800-622-2255
    National Crisis Line – Anorexia and Bulimia: 1-800-233-4357
    GLBT Hotline: 1-888-843-4564
    TREVOR Crisis Hotline: 1-866-488-7386
    AIDS Crisis Line: 1-800-221-7044
    Veterans Crisis Line: https://www.veteranscrisisline.net
    TransLifeline: https://www.translifeline.org – 877-565-8860
    Suicide Prevention Wiki: http://suicideprevention.wikia.com



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    *Use mouse or cursor to sign.
    By signing, I hereby affirm that I am the parent or legal guardian of the minor and have custody rights. *Use mouse or cursor to sign.
    If you are a legal guardian of the client please print your name


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