Safety Net Program
Self-enrollment form to receive follow-up phone calls or texts from Dial Help, with the goal of helping you access professional treatment or counseling services, and supporting you in staying stable until you do.
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to save your progress.
DO NOT FILL OUT THIS FORM FOR SOMEONE ELSE
Because of consent issues, you may HELP someone else sign up by filling this form out WITH them, but DO NOT fill it out on your own for someone else.
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This form was created inside of Dial Help Inc.