Help us Build TWLOHA's FIND HELP Pages

Recommendations for TWLOHA's FIND HELP resource page

Part of To Write Love on Her Arms's mission is to connect people to resources in their community. In honor of National Suicide Prevention Week (9/10-9/16), we are asking for your help to identify mental health resources, professional treatment options, and support groups in communities across the U.S. and internationally. Your recommendations will serve as a starting point for our team to connect people to the help they need and deserve.

Provide as much information as you can, but it's okay if you have to leave some portions blank.

We greatly appreciate your help in this project!

Question Title

* 1. Tell us about you!

Name

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Question Title

* 2. What is your age?

17 or younger

18-20

21-29

30-39

40-49

50-59

60 or older

The next set of questions is to provide information about your recommendation.

Please note, if you have more than one recommendation, please complete the recommendations one at a time.
If you are unsure about a service offered, or specialty, feel free to leave a portion blank. But, the more information we have the better!

Question Title

* 3. Please provide us with information about your Mental Health Resource Recommendation

Company *

Website

Address

City/Town

State/Province

ZIP/Postal Code *

Country *

Email Address *

Phone Number (Please include the full phone number including country code) *

Question Title

* 4. Please provide us with a contact for this resource

Name

Company

Title

Email Address

Phone Number

Question Title

* 5. Please select the descriptions that fits your recommendation. You may choose as many that apply.

Is a non-profit organization (IRS status 501(c)(3))

A for-profit mental health provider (Privately owned)

Waiting on non-profit status approval

Is a Licensed Mental Health Provider

Other (If this is an international resource, please specify the type of resource)

Question Title

* 6. Are they accepting new clients?

Yes

No, they have a wait list.

I'm not sure.

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* 7. Please describe the main mission or purpose of the recommendation.

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* 8. If the recommended resource offers counseling services, please indicate the total number of licensed counselors, individuals working toward licensure, and any other credentials.

# of Licensed Counselors

# of Counselors working toward Licensure

# of staff with other certifications

Other:

Question Title

* 9. Please briefly describe any personal experience you've had with this recommendation.**
If you are a representative or employee of the resource recommended, please disclose that here.

Question Title

* 10. Please check what type of services are offered. You may select as many that apply.

Individual Counseling

Group Counseling

Intensive Out-Patient programs

Residential Treatment Center

Aftercare

Support Groups

Detoxification

Crisis Center or Hotline

Other (please specify)

Question Title

* 11. Please indicate if the provider has any specialties in treating the following:

depression

addiction

self-injury / self-harm

anxiety

eating disorders

trauma

abuse

loss / grief

Other (please specify)

Question Title

* 12. Do they offer any financial assistance or sliding scale for clients? Please choose any options that are offered.

Sliding Scale Fees (Rates are based on income)

Reduced Rates (Rates may be reduced based on Level of Expertise)

Financial assistance or scholarship program

Student Discounts

Accepts Medicaid / Medicare / Other government assistance programs

Accepts Insurance

Other (please specify)

Thank you for submitting your mental health provider recommendation! We're so grateful to have you joining us in building this network.

Please feel free to complete the survey as many times as you'd like with additional recommendations.

Question Title

* 1. Tell us about you!

Question Title

* 2. What is your age?

Question Title

* 3. Please provide us with information about your Mental Health Resource Recommendation

Question Title

* 4. Please provide us with a contact for this resource

Question Title

* 5. Please select the descriptions that fits your recommendation. You may choose as many that apply.

Question Title

* 6. Are they accepting new clients?

Question Title

* 7. Please describe the main mission or purpose of the recommendation.

Question Title

* 8. If the recommended resource offers counseling services, please indicate the total number of licensed counselors, individuals working toward licensure, and any other credentials.

Question Title

* 9. Please briefly describe any personal experience you've had with this recommendation.**If you are a representative or employee of the resource recommended, please disclose that here.

Question Title

* 10. Please check what type of services are offered. You may select as many that apply.

Question Title

* 11. Please indicate if the provider has any specialties in treating the following:

Question Title

* 12. Do they offer any financial assistance or sliding scale for clients? Please choose any options that are offered.

Question Title

* 13. Is there any additional information that you'd like to share with us about this recommendation?

* 9. Please briefly describe any personal experience you've had with this recommendation.**
If you are a representative or employee of the resource recommended, please disclose that here.