Emergency Information: If you are in immediate risk of harming yourself of someone else, please contact the Crisis Lifeline at 1-800-273-8255 (Press 1 for veterans), text 838255, call 911, or proceed to the nearest emergency room.

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Who are you requesting help for?

What's theiryour age group?

Are theyyou experiencing any nightmares or sleeplessness?

Are theyyou having trouble finding or keeping a job?

What does theiryour living situation look like?

What's theiryour gender?

What state are theyyou located in?

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What's theiryour name?

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What's your name?

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Thanks for that. What number can we reach you at?

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Great. What's the best email for you?

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In a few words describe what theyyou are going through.