Client intake form

Emergency assistance notice:

If you or someone you know is in immediate life-threatening danger, please call 911.

For suicide prevention and crisis support, dial 988.

For the National Domestic Violence Hotline, call 1-800-799-7233.

We provide compassionate, faith-based guidance and non-medical support for individuals facing trauma, substance abuse, and life transitions across Millington, Tipton County, and Lauderdale County. This form can be filled out directly by the person seeking care or by a caring family member, pastor, or referring agency. Once submitted, your confidential information is routed directly to a certified care coordinator who will connect with you within one business day.