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Peer Support Request

Your request is confidential. We don’t share peer support details, and we recommend using a personal email. If there's risk of harm to self or others, we may act to ensure safety. Please let us know how to be of support by answering the following questions in as much detail as you can.

Click the button below to enter info:

Start

Question 1 of 5

Your name and contact information. Please provide email, phone/text and any other information we may need to contact you and/or follow-up later.

Question 2 of 5

Please tell us how we can be of support. Describe incident, concerning behavior, personal reactions, group experience, etc. so that we are able to find the peer best suited to provide support.

Question 3 of 5

What actions have already taken place? (Debrief, counseling, peer support, supervisory discussion, or any other you would like to mention)

Question 4 of 5

What are you looking for from our peer support team?

Question 5 of 5

How quickly do you need/want to be contacted for support?

A

Immediately - within an hour

B

Quickly - within 24 hours

C

Soon - within 2-3 days

D

No rush - within 1 week

Confirm and Submit