LGBTQIA Welcoming

Client Forms

If you are new, please feel free to fill out these intake forms before our first session. These forms can also be filled out during the first session.

If you feel that you would like to collaborate your session with another provider, simply fill out the following form.

Authorization for Release of Information

Contact

CRISIS SITUATIONS

In Cases of Emergency - Dial 911 or 988 For urgent issues, Philadelphia has 24-hour Crisis Response Centers (CRCs). Information can be found at DBHIDS or by calling 215-686-4420. The Philadelphia Mobile Treatment team can be reached at 215-685-6440. If any of these numbers do not work, call 911. Patients and individuals living outside of the Philadelphia area can also call 911 or go to their nearest ER.

HOTLINES

Drug and Alcohol Treatment Hotline - 1-800-662-HELP
National Child Abuse Hotline - 1-800-4-A-CHILD
National Domestic Violence Hotline - 1-800-799-7233
National Suicide Hotline - 1-800-784-2433