Pathfinders Support Request Form
Welcome to the Mount at Chesapeake Pathfinders Intake Process.

If this is an emergency, please contact 911 immediately or redirect your request to one or more of the following:

Suicide & Crisis Hotline - #988
National Homeless Hotline - 1-800-621-4000 
Domestic Violence Hotline - 1-800-799-7233
National Runaway Safeline - 1-800-786-2929

The information requested in this form is confidential and intended to be used by a carefully curated team of Pathfinders who will work to assist you with your request and/or identify the most suitable resources. We kindly request that you thoroughly and thoughtfully answer each question. Upon completion, we will carefully review the information provided and respond within 24-72 hours (please note that Pathfinders support is only available on weekdays).

Service is accessible to Mount Partners who are 18 years or older. 
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Email *
Name *
Please Select your Mount Location *
Age
Marital Status *
Gender Identity *
Best Contact Number *
Preferred Method of Contact *
Best Time to Call or Contact *
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As Best you can please select a Category that supports your Needs. *
Please provide any additional details that you feel would help us serve you best *
Is this the first time that you have used this service? *
This Service is only available for Mount Partners.  By Choosing and agreeing to move forward with this Support consideration, it is understood that you agree to being contacted (and a message to be left if applicable) and that you accept full responsibility for the information that is shared.  In addition, you give "The Mount" permission to assess and discuss options that are determined to best suit your individual needs.  

For a full list of Disclosures, click Here to review
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By Checking this box, you confirm that you understand and agree to the terms for support
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