Request a Call Back from Solace House

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Request a Call Back from Solace House

If reaching out by phone feels hard, you can request a call back here and a member of the Solace House team will reach out to you.

Your privacy matters to us. Information shared through this form is kept confidential and is only reviewed by the Solace House team for the purpose of returning your call and connecting you with support.

This form is not for emergencies. If you are in immediate danger, please call 911 or NYC Well at (888) 692-9355.

Email *

First name

What would you like us to call you?

Phone number

The best number to reach you for a call back. Let us know if texting is okay if we’re unable to reach you by phone.

Email address

We will use this if we’re unable to reach you by phone.

Best time(s) to call you

We will use this if we’re unable to reach you by phone.

Morning

Afternoon

Evening

Flexible

What are you hoping for support with?

You can share as much or as little as you’d like. Any information you choose to share is confidential and helps us respond thoughtfully.

Are you reaching out for yourself or someone else?

For myself

For a family member or loved one

For general information

Clear selection

Have you connected with Solace House before?

Yes

Not sure

Clear selection

Confidentiality + Safety Acknowledgement (Required)

I understand that information shared through this form is confidential and will only be accessed by authorized Solace House staff or trained volunteers for the purpose of returning my call and offering support. I also understand this form is not for emergencies.

Confidentiality Notice

The information you provide through this form is confidential and will only be used by Solace House to return your call and offer support. We do not share this information outside of Solace House, except as required by law.

If this is a mental health emergency, please call 911 or NYC Well at (888) 692-9355.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Solace House.

Does this form look suspicious? Report

Forms