Initial Consultation Name * First Name Last Name Phone (###) ### #### Email Preferred Contact Method & Times Your family member’s name for whom you are seeking LIGHTS services (if not same as above) Their date of birth MM DD YYYY Tell us a bit about you and why you are looking to connect with LIGHTS How did you hear about LIGHTS? Thanks for your inquiry! We will endeavor to provide a timely response to your inquiry Please note our eligibility criteria to engage with LIGHTS If this is a crisis, please contact Crisis Response at the DSO
