Crisis Support Intake Form (988 Companion)

Crisis Support Handoff Form

Designed to quickly capture details to pass along to 988 counselors.

Immediate Danger Notice: If the person is in immediate physical danger or has already acted, please call 911 or local emergency services immediately.

1. Personal & Location Information

Individual's Name (or Preferred Name):

Age / Pronouns:

Current Physical Location / Address:

Phone Number (if applicable):

2. Nature of the Crisis

What are they expressing or feeling right now?

Suicidal Intent / Plan / Means:

3. Background & Safety Context

Substance Use / Medical Context:

Is the individual a Military Veteran? (Routes to 988, Press 1)

Generated Summary for 988 Chat/Call

Copy this structured summary and paste it into the 988 online chat box or read it to the phone counselor: