Name and email are enough
Phone, location, and extra details are optional. Use the safest contact method for your situation.
Private intake
Use this page when the situation involves work, a person in power, a facility, foster care, detention, medical care, therapy, caregiving, retaliation concerns, or an assault connected to services or an opportunity.
Before you send
Phone, location, and extra details are optional. Use the safest contact method for your situation.
The intake request is used to understand the situation and help narrow the resource path. We do not contact employers, facilities, agencies, or care providers from this form.
A few words like supervisor, retaliation, coworker, foster care, detention, nurse, therapist, caregiver, or workplace harassment are enough to start.