CLT Uprising Mental Health Request
IF YOU ARE EXPERIENCING A MEDICAL/PSYCHIATRIC EMERGENCY PLEASE DIAL 911. If you need to access FREE and CONFIDENTIAL mental health support in response to the events leading up to the Charlotte Uprising OR you think someone you know can benefit from speaking with someone, please complete this form. All information obtained is completely confidential and is monitored by a Licensed Professional. All available clinicians are volunteering their time and will try to accommodate needs as they arise. Support is available in person and virtually (video conferencing, telephone.) A mental health clinician will contact you following your request.
Name *
Your answer
Preferred Pronouns (she, he, they, etc.) *
Your answer
Email *
Your answer
Phone number *
Your answer
Do you have access to transportation? *
Do you have access to Wifi?
Briefly tell us how you've been impacted during the Uprising: *
Your answer
What are you looking for in a counselor (e.g., race, gender identity, etc?) Briefly tell us how we can support you: *
Your answer
Do you live in Charlotte/immediate area?
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