Confidential form to connect you with mental health resources and assistance. Name * First Name Last Name Email * Phone * (###) ### #### Type of Assistance Needed * Counseling/Therapy Referrals Crisis Support Resources Youth/School-Based Support Domestic Violence/Abuse Resources Substance Use/Opioid Support General Mental Health Information Other Urgency of Request * Immediate- PLEASE CALL 988 SUICIDE & CRISIS LIFELINE Within the next week Ongoing/general support Please share a little about what you’re seeking or how we can help. * Permissions/Consents * I understand this form is not an emergency resource. If I am in crisis, I will call 988 (Suicide & Crisis Lifeline) or 911. I consent to A Walk With Britt contacting me regarding the information I provided.” Thank you for trusting A Walk With Britt. Your request has been received, and our team will reach out to you within 48 hours. If you are in immediate crisis, please call 988 right away.