Intake Form

All information that you submit through this online form is also protected by our confidentiality policy, and will only be seen by The Initiative’s advocates. If you mention child abuse in this form, we will have to report it. If you have any questions about our confidentiality policy, please contact us directly at 303-839-5510 or and we can go over it together.

Please remember that we do not require answers to any of these questions! We ask these questions as a starting place for our advocates to get a sense of what’s going on and what resources might be available to help you. You can leave any of the questions blank. Some of these questions might be triggering, or hard to answer. Please take care of yourself as you fill out this form. We know how hard it can be to reach out for help – we appreciate you and your courage in starting this journey. 

At this time, we do not serve survivors who reside outside the state of Colorado. 

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