This form is to request to speak with your counselor. Please submit this form and your counselor will get back to you to set up a time to talk.
Please note: If you leave a phone number, we will be calling from a restricted number with a blocked caller ID.
*If this is an emergency please get an adult now.
Please contact SAFTY at 1-888-334-2777 if you are having feelings of hurting yourself or others, or call 911.
