Name *

First Name

Last Name

I'm interested in help with... *

Depression (feeling sad, lonely, bored and unsure of what to do next)

Feeling suicidal

Anxiety (constant fear, feeling like a social outcast, worried about "going crazy", panic attacks)

Stress (feeling overwhelmed by life and/or unable to cope)

How to cope with a bad medical diagnosis (how do I move on from here? I'm not ready to give up or I AM ready to give up)

Caregiving responsibilities (feeling like I can't do it by myself, feeling like I'm not strong/patient/kind enough)

Alcohol or drug abuse

Other