This form is used to gather information after an initial conversation to determine next steps and appropriate services.
Submission of this form does not commit you to services.
Service Request
INITIAL INTAKE & REQUEST FOR SERVICES
If at any point you feel unsafe or in crisis, please contact 988 (U.S.) or local emergency services. Text-based peer support is not a crisis service.
Bridging Seasons LLC - Intake Form - Version 1.0 - For internal and professional use only
Important Information
Services offered are non-clinical and not therapy.
This service is not for emergencies.
Confidentiality has limits related to safety and mandated reporting.
Additional details are available here:
Adult Participation Agreement- Acknowledgement
Prior to participating in services, a full Participation Agreement will be provided for review and completion.