We’re glad you’re here.Looking to talk right away? Consider calling *988— Name * First Name Last Name Your relationship to the person needing assistance: * Self Mother Father Son Daughter Friend Other Please check below what you are currently struggling with: * Drugs/Alchohol Self-Harm/Suicide Behaviors Eating Issues (Bing/Purge/Restrictive) Mental Health Struggles Sex Issues (Sex/Porn/Relationship Addiction) Best way to contact you: Phone Text Email Best time to contact you: Phone Number: * (###) ### #### Text Number: (###) ### #### Email Thank you for reaching out! A Reclaiming Hope team member will be in touch with you shortly.—If you struggling and need help right away, please consider calling *988.