Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
The Center for Hope and Healing, Inc. Request for Counseling/Advocacy
Please complete this form if you or someone you know would like short term trauma counseling or sexual assault advocacy services.
Be advised that the current wait time for ongoing counseling support is about 3 weeks to intake.
If you are in need of immediate or crisis support, please reach out to our 24/7 Hotline at 800-542-5212.
Sign in to Google
to save your progress.
Learn more
Next
Page 1 of 4
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
