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NCS Critical Support Team Remote Referral
If a crisis has occurred and you need support, please use this form. Someone will contact you ASAP
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Email
*
Your email
Name of Individual Being Referred
*
Your answer
Name of Person Completing Form
(If different than the person being referred)
Your answer
Concerns (Why do you feel this person needs to be contacted? This helps with determining how to support the individual.)
*
Your answer
Contact Method- provide phone, email, etc. of the person you are are referring
*
Your answer
Best Time to Contact
Your answer
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