Start Safe Online Intake

Short, trauma-aware, mobile-first. Your progress is saved automatically.

Just the essentials

It's ok to use an alias

Immediate Safety Tips

If you're in immediate danger, call 911. To quickly leave this page, click the Quick Exit button below. This will redirect you to a weather website and attempt to clear this page from your browser history.

No exact address required

Help us prepare (optional)

We only collect what's necessary to keep you safe and cared for. You can skip any question. Data is encrypted and access is restricted.

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Thank you for reaching out. Your safety and wellbeing are our priority.

Estimated callback: within 15 minutes

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