Crisis Lines Feedback & Change Request Form

Crisis Lines Feedback and Requests Form
This form is to provide feedback, report out-of-date information, or request any changes to the clinical or operational processes at Lines for Life. Your request will be reviewed by Crisis Lines Leadership. Please note that not all changes can be accommodated but each change request will be put under consideration.
Name*

First NameLast Name
Your Email*
example@example.com
Date*

MonthDayYear
Date
Department/Nature of Request*

Crisis LinesData RequestFeedbackQuality AssuranceRequest to add/update/remove a resource from the databaseTrainingUpdate outdated procedure, policy, or documentOther
Please keep in mind that the Data Team is currently handling a high volume of requests. To ensure we can assist you efficiently, we kindly ask that you submit well-considered and relevant requests. This will help us prioritize and address the most critical needs effectively. Additionally, please note that all requests are subject to leadership approval.

This form is specifically for members of the Crisis Lines department. If you are from another department, please follow the separate process designated for your team. Thank you for your understanding and cooperation.
I would like to:*

Add a resourceRemove a resourceUpdate a resource
Name of Resource*
Website Address*
Description*
Change Request*
Categories - Please check all that apply.*

Advocacy/EducationAlcohol and DrugBIPOCChronic Pain ManagementCrisis Lines/Resource LinesCulturally-Specific ResourcesDisabilitiesDomestic Violence/Sexual AbuseEating DisordersEmergency ServicesEmploymentFinancial SupportFoodGambling Treatment ServicesHospitalsHousing & ShelterLGBTQ+Medical/DentalMental HealthMilitary and VeteranOlder Adult/Senior ServicesOnlinePeer SupportPrevention ServicesSexual AbuseSupport Groups/CommunityYouthYouthLine (these are YL-vetted resources)
Feedback*
Should be Empty:

Crisis Lines Feedback and Requests Form