Contact us

Emergency Assistance

If this is an emergency, call:

Elliott Community Services Crisis Line: 1-800-988-1111
988
Crisis Text Line 741 741

Client Information

Client's name

Client's Last name

Parent's name (if client is a minor)

Parent Last name

Email address (parent email if client is a minor)

Phone number (parent phone number)

I consent to be contacted by Launch staff via text (this box must be checked if you wish to be able to communicate with your clinician via text message)

Client's Date of Birth

About Your Appointment

Who referred you to us?

Please write a brief description of the reason that you are reaching out to us

Additional information

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