Coalition of Clinician Survivors
The Coalition of Clinician Survivors (CCS) provides support & resources to clinicians & other professional caregivers with the experience of suicide loss of patients/clients, family members, loved ones, students &/or colleagues.

To be considered for membership, please provide the information below, knowing that it will only be available to the Chairs of this group. We do not share it with others.  We understand that it takes bravery to let people know that we have experienced suicide loss(es).  We are requesting the info to help inform activities of this group, such as support groups for different categories of suicide loss of our members.  Thank you for understanding
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Email *
Name: *
Pronouns:
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Discipline: *
Current Residence (City, State, Country)
Email to be used for list serve (Note: Most .edu, .gov, and some other business email servers do not allow accessing GoogleGroups.)
Type of Suicide Loss : *
What year did this loss occur?
Please list the relationship and year of any other losses to suicide.
How did you hear about the Coalition for Clinician Survivors?
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If you heard about us from a friend, colleague or training, please let us know who it was:
Thank you!  If you have any other thoughts or questions, please tell us here or email us at email info@cliniciansurvivor.org.
A copy of your responses will be emailed to the address you provided.
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