Get Help

Name *

First Name

Last Name

Phone

(###)

###

####

Are you a social service provider or potential client?

Service Provider

Potential Client

Are you in immediate danger and are fleeing?

Yes

No

Is someone forcing you to do something you don’t want to do?

Yes

No

Is someone holding your personal identification and you do not have access to it upon ask?

Yes

No

Will you be threatened or harmed if you leave this situation?

Yes

No

Do you have access to medical care?

Yes

No

What is the best way to communicate with you?

Check all that apply

Phone

E-mail

Is it safe to identify ourselves as SFSH? *

Yes

No