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If you need suicide or mental health-related crisis support, or are worried about someone else, please call or text 988.

Feedback Form For Guardians

Thank you for your interest in the Behavioral Health Provider Registry.  We are interested in learning a little about the people who have engaged with the registry and their experiences.  WE would be grateful if you could complete this brief survey.  Thank you.   If you have any questions about the registry, please contact us at info@preventsuicidenj.org.

If you need immediate help with a physical health emergency/crisis please contact 911; if you are seeking immediate help with an emotional health emergency/crisis please contact 988.  For additional mental health support, please contact PerformCare.

Please share with us a little about your child for whom you were seeking resources

What is the child's sex?(Required)
What is the child's racial/ethnic background? [CHECK ALL THAT APPLY](Required)
What was the primary challenge that you were seeking support? (Check all that apply)(Required)
Did you find navigating the registry challenging?(Required)
How satisfied were you with the experience using the registry Not at all satisfied(Required)
Were you able to connect with a provider that you and your child were satisfied with?(Required)