For Individuals & Families

Let's find the right support for you.

Fill out this short form and someone from our team will call you within 1–2 business days. You don't need to have everything figured out — we'll help you from here.

Prefer to call? Reach us at (252) 572-6547.

Your name *

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County you live in *

What kind of support are you looking for? *(check all that apply)

Best time to call you *

Anything else you'd like us to know? (optional)

Please do not include diagnoses, medications, insurance numbers, Social Security numbers, crisis details, or any private health information in this field. A team member will call you to complete intake through a secure process.

This form collects general contact information only — no Protected Health Information (PHI) is transmitted here. Your information is kept private and will only be used to follow up with you. We never share your information without your consent. View our Notice of Privacy Practices.