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Request A Peer Support Call From SQSH
Fill out this form to have a SQSH peer counselor call you at a scheduled time. We will call either from a blocked number (no number in the caller ID) or from the SQSH helpline number. Unless otherwise requested, we will usually not leave a voicemail if you do not answer.
We know it can be difficult to make a phone call or reach out for support. We hope this form makes it easier for you to connect with us. Fill it out to request a conversation with a peer support volunteer and we will call you. All you have to do is answer 💜
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* Indicates required question
How would you like us to address you in the call? A name or alias lets us verify we are talking to the correct person to protect your privacy. You may also include pronouns if you would like.
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Your answer
When would you like us to call you? Please choose a date and time within our hours of Friday-Monday, 1:00pm-7:00pm, and please allow at least 24 hours for us to process your request.
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MM
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YYYY
Time
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AM
PM
What phone number would you like us to call? Please include area code.
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Your answer
Would you be comfortable with a SQSH peer counselor leaving a voicemail at the phone number you provided?
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Yes
No
Other:
I acknowledge that a SQSH peer counselor will do their best to give me a call at the above phone number, from an anonymous phone number, for up to 3 attempts in the coming month, as close to the date & time I provided as possible.
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Yes
No
Other:
(Optional) What would you like to talk to us about?
Your answer
(Optional) Anything else you want us to know?
Your answer
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