Name * First Name Last Name Email * Phone (###) ### #### Gender * Male Female How can we help you? * Please choose a category that best describes the area in which you would like help. Abuse Sexual Abuse If you think you might be pregnant and are not sure what to do next Un-Planned Pregnancy Post-Abortive Care Addiction of any kind In need of Counseling / Mental Health Other (Please describe below) Anything else? Tell us anything else that you think might be helpful. Thank you for reaching out to the Vertical Care Team! We will contact you within the next 24 hours to discuss next steps. Do you need help immediately? Are you having suicidal thoughts or need to talk to someone right now Call or Text: 988 If you feel unsafe in your current situation: Call: 911 The information provided on this form will be handled confidentially by the Vertical Care Team.
