JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Request A Peer Support Call From SQSH
Fill out this form to have a SQSH peer counselor call you at a scheduled time. We will call either from a blocked number (no number in the caller ID) or from the SQSH helpline number. Unless otherwise requested, we will usually not leave a voicemail if you do not answer.
We know it can be difficult to make a phone call or reach out for support. We hope this form makes it easier for you to connect with us. Fill it out to request a conversation with a peer support volunteer and we will call you. All you have to do is answer 💜
Sign in to Google
to save your progress.
Learn more
* Indicates required question
How would you like us to address you in the call? A name or alias lets us verify we are talking to the correct person to protect your privacy. You may also include pronouns if you would like.
*
Your answer
When would you like us to call you? Please choose a date and time within our hours of Friday-Monday, 1:00pm-7:00pm, and please allow at least 24 hours for us to process your request.
*
MM
/
DD
/
YYYY
Time
:
AM
PM
What phone number would you like us to call? Please include area code.
*
Your answer
Would you be comfortable with a SQSH peer counselor leaving a voicemail at the phone number you provided?
*
Yes
No
Other:
I acknowledge that a SQSH peer counselor will do their best to give me a call at the above phone number, from an anonymous phone number, for up to 3 attempts in the coming month, as close to the date & time I provided as possible.
*
Yes
No
Other:
(Optional) What would you like to talk to us about?
Your answer
(Optional) Anything else you want us to know?
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms