Support Program for COVID-19 First Responders and Healthcare Professionals (and their families)
THANK YOU SO MUCH FOR YOUR SERVICE AND FOR PROTECTING US AND THE PUBLIC. Our gratitude is unmatched and while you might not always be recognized for your work, you are appreciated and seen.

Reloveution has created a bank of mental health professionals from around the country who have volunteered clinical hours to virtually support COVID-19 first responders, healthcare professionals, and their families. ALL SESSIONS ARE COMPLETELY FREE AND YOU CAN REQUEST AS MANY AS YOU NEED FOR AS LONG AS IT TAKES! Any first responder or healthcare professional can request a support session and will be matched with a professional within twenty-four hours. Scheduling and mode of virtual meeting will be handled directly between the requester and the mental health professional.

Your information is only accessible by one person at Reloveution and will only be shared with the mental health provider you are matched with to help support your session. We take your privacy VERY seriously and promise to keep your information safe.

While therapeutic techniques may be used in these sessions, the primary purpose is to respond to acute stress and provide a space for first responders to be heard and supported in a crazy and unpredictable time. This is not therapy or counseling.

If you have a significant, diagnosed mental health challenge, we encourage you to seek ongoing support through traditional means.

If you are currently in crisis, please go to the emergency room or call 911. If you are currently experiencing thoughts of suicide, please call 1-800-273-8255 or use the online chat (https://suicidepreventionlifeline.org/chat/).

**If you are concerned about your information staying secure, please email us at covidmentalhealth@gmail.com and we can set a session up for you without you filling out the form.
First Name *
**please note that this form is NOT for volunteers. If you are interested in volunteering as a mental health practitioner, please fill out this form instead: http://bit.ly/covidfirstresponder
Last Name *
**please note that this form is NOT for volunteers. If you are interested in volunteering as a mental health practitioner, please fill out this form instead: http://bit.ly/covidfirstresponder
Email Address *
Phone Number *
I am a... *
Preferred Method of Communication (for setting up appointment) *
How long of a session are you requesting? *
What is your availability for a session? *
Required
Where are you located? (City, State) *
Job Title
Are you employed by any of these companies?
THIS WILL NEVER BE SHARED WITH EMPRESS. We are just trying to gauge how many people are taking advantage of the service.
Clear selection
Would you prefer to be matched with a practitioner who speaks a language other than English? If yes, list the language below and we'll do our best!
Would you prefer to be matched with a practitioner with a shared racial identity? If yes, list your race/ethnicity below and we'll do our best!
What type of support are you looking for? *
Are you looking for somebody to just listen to you? Are you hoping to build coping skills? Are you interested in mindfulness practices? Do you need support navigating your stress? Do you need help solving a problem? Let us know how we can help!
What are you looking for right now?
Clear selection
Please list the names of TWO emergency contacts including name, relationship to you, phone number, and email address *
These contacts will ONLY be contacted if there is an emergency
Where did you hear about this service? *
Would you be interested in receiving mental health resources, self-care training, or other support besides a listening session from Reloveution?
Clear selection
I understand that this program is comprised of volunteers who are not being compensated for their time. I agree to honor the time of these volunteers by responding to correspondence and showing up for appointments *
I understand that although therapeutic techniques may be used, this program is not therapy, counseling, or ongoing mental health support. *
Anything else you'd like us or your practitioner to know?
Please type your name to affirm your understanding of the above and give your consent for us to share the information in this form with your assigned practitioner *
Submit
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