Forms
Get the most from your visit with The Clinical Care Team of Community Counseling.
While bringing the completed forms with you can save time in our waiting room, emailing it to us ahead of your appointment will enable us to review the information prior to seeing you. Please print the appropriate form below and email the completed form to ccsainfo@counselingandwellness.com before your scheduled appointment.
*If you are completing the couples inventory form please ensure that both parties each complete a copy.
Resources
DCFS Hotline
800-252-2873
State central register for reports of child abuse and neglect
SAFE (Self-Abuse Finally Ends)
1-800-DONT-CUT
(1-800-366-8288)
www.selfinjury.com
Kid Help
1-800-543-7283
Children and adolescents in crisis will receive immediate help. Referrals to shelters, mental health services, sexual abuse treatment, substance abuse, family counseling, residential care, adoption/foster care, etc.
Al-Anon/Alateen Hotline
1-800-344-2666
Hope & Help for young people who are the relatives & friends of a problem drinker.
www.al-anon.alateen.org
National Institute of Mental Health Information Line
1-800-647-2642
Provides information and literature on mental illness by disorder – for professionals and general public.
www.nimh.nih.gov
Additional Hotline Numbers
Adolescent Suicide Hotline 800-621-4000
Adolescent Crisis Intervention & Counseling Nineline 1-800-999-9999
AIDS National Hotline 1-800-342-2437
CHADD-Children & Adults with Attention Deficit/Hyperactivity Disorder 1-800-233-4050
Child Abuse Hotline 800-4-A-CHILD
Cocaine Help Line 1-800-COCAINE (1-800-262-2463)
Domestic Violence Hotline 800-799-7233
Domestic Violence Hotline/Child Abuse 1-800-4-A-CHILD (800 422 4453)
Drug & Alcohol Treatment Hotline 800-662-HELP
Ecstasy Addiction 1-800-468-6933
Eating Disorders Center 1-888-236-1188
Family Violence Prevention Center 1-800-313-1310
Gay & Lesbian National Hotline 1-888-THE-GLNH (1-888-843-4564)
Gay & Lesbian Trevor HelpLine Suicide Prevention 1-800-850-8078
Healing Woman Foundation (Abuse) 1-800-477-4111
Incest Awareness Foundation 1-888 -547-3222
Learning Disabilities (National Center For) 1-888-575-7373
Mental Health InfoSource 1-800-447-4474
Missing & Exploited Children Hotline 1-800-843-5678
National Alliance on Mental Illness (NAMI) 1-800-950-NAMI (6264)
Panic Disorder Information Hotline 800- 64-PANIC
Post Abortion Trauma 1-800-593-2273
Project Inform HIV/AIDS Treatment Hotline 800-822-7422
Rape (People Against Rape) 1-800-877-7252
Rape, Abuse, Incest, National Network (RAINN) 1-800-656-HOPE (1-800-656-4673)
Runaway Hotline 800-621-4000
Self-Injury Hotline SAFE (Self Abuse Finally Ends) 1-800-DONT CUT (1-800-366-8288)
Sexual Assault Hotline 1-800-656-4673
Sexual Abuse – Stop It Now! 1-888-PREVENT
STD Hotline 1-800-227-8922
Suicide Prevention Lifeline 1-800-273-TALK
Suicide & Crisis Hotline 1-800-999-9999
Suicide Prevention – The Trevor HelpLine 1-800-850-8078
(Specializing in gay and lesbian youth suicide prevention).
Teen Helpline 1-800-400-0900
Victim Center 1-800-FYI-CALL (1-800-394-2255)
Youth Crisis Hotline 800-HIT-HOME