If you are experiencing a life-threatening situation please call 911 or immediately go to an emergency room.
If you are experiencing suicidal thoughts, homicidal thoughts, domestic violence, or substance abuse is the primary concern of your request, DO NOT complete this form. Please call Concern's 24/7 toll-free number at (800)344-4222.
We request the following information as a quick and easy way to refer you to a professional. Our questions screen for your health and safety, which is our primary concern.