Request Intake
Start with contact and fit—not a public upload of sensitive health information.
This intake request is intentionally minimal. A qualified program representative or partner site should complete any detailed readiness, safety, or referral screening through an appropriate secure process.
Before you submit
Do not send medical records or detailed health information here.
This public form should be used only to request contact about a cohort. Detailed screening should occur through an approved secure workflow after the program contacts you.
EMERGE 8 is not an emergency or crisis service. If you need immediate medical or safety assistance, use the appropriate emergency or licensed local service rather than waiting for an intake response.