Intake Form

If you have inconsistent internet access or for whatever reason are unable to input to this form directly, a downloadable version is available here: fD Distress Services Intake Form

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Intake Form

  • APPLICANT INFORMATION

  • CASE INFORMATION

  • Please be sure to click “Submit” and wait until your browser finishes before going to another page. You may wish to print this page, or copy and paste your answers into an email to us, to ensure your submission is saved, in case it doesn’t go through. Please contact us at distress@freedimensional.org if you need any help getting this form submitted to us. Thank you! PLEASE NOTE: All cases all carefully vetted by freeDimensional staff and volunteer Distress Services case consultants. Due to the high volume of requests and varying levels of urgency, the average response time is three days to one week.
 

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