Intake form

We require an initial intake before attending the support groups ran by The Other Six. This form is the first connection to an important beginning to the healing process, as it serves as an introduction to our services and opportunity for us to get to know you and your needs.

 

Please fill out the form below to request an intake and a counselor will follow up with you within 72 hours. Please note that due to privacy laws, we cannot accept intake requests that are made on behalf of another person, unless the individual is under 18. 

Intake Request Form
What is your prefered method of contact? *
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About The Other Six

The Other Six is a nonprofit based out of Seattle, Washington. This official 501c3 nonprofit is run by medical/business professionals and teenagers. 

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© 2019 by The Other Six. All rights reserved. EIN# 82-3590061