My child needs help!
Please fill out the below questionnaire and we will get back to you within 24 hours for assistance.
IF THIS IS AN EMERGENCY, PLEASE CALL 9-1-1.
What is your name?
What is your child's name?
How old is your child?
Between the ages of 10-13
Between the ages of 14-17
What is your phone number?
What is your email address?
What is your zip code?
What is the best way to reach you?
Where is your child now?
Please select all that apply to your child:
Sexual Behavior Problems
Sexual Exploitation/Human Trafficking
Fire Setting Behaviors
Depression or Anxiety
Is your child taking any prescribed medications?
What medications are prescribed to your child?
If none, please type N/A, or indicate if there are any prescription medications that are being abused without a prescription.
How did you hear about us?
Miami Bridge Street Outreach
Miami Bridge Flyer
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