I need help!

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I need help!

Problems at school? No place to sleep? Family driving you crazy? Frustrated? Angry? Fearful? Alone? Depressed? Anxious? LET US HELP! We will respond to you within 24 hours.

IF THIS IS AN EMERGENCY, PLEASE CALL 9-1-1. If you are considering hurting yourself or need to talk to someone right away, please call 1-800-273-TALK (8255).

What is your name? *

If you prefer to remain anonymous for now, please just say so. Or, you can use a nickname.

How old are you? *

Miami Bridge serves youth ages 10-17.

I am under 10.

I am between 10-12 years old.

I am between 13-17 years old.

I am over 18 -24 years old.

What is your phone number? *

If you do not have a phone number where we can reach you, please write "none". Please give us at least one way to reach you.

What is your email address? *

If you do not have access to an email address, please write "none". Please give us at least one way to reach you.

What is your zip code? *

What is the best way for us to reach you? *

Phone

Other:

What issues are you facing? *

I am always angry.

I want to hurt myself.

I ran away from home.

My family is driving me crazy.

I do not feel safe.

I am always anxious, depressed, or fearful that something bad will happen.

I don't have anywhere to go.

Other:

Required

Are you taking any medications currently? *

Yes

Is there anything else you would like us to know at this time? *

What languages do you speak? *

Que idioma hablas?

English

Espanol

Francais

Creole

Other:

Required

How did you hear about us?

Internet Search

I found a Miami Bridge Flyer

The Miami Bridge Outreach Team was at School or at an Event Near Me

Other:

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