Client intake form

This page is to be used by SGS staff, Certified facilitators, and trained volunteers.  

Read Disclaimer:  The information given on this call is a public service and courtesy. This information shall not be construed as legal, medical, or mental health advice.  By continuing with this conversation, you are agreeing that SGS will not be held liable for any action taken as a result of this call.  SGS reserves the right to report to the proper authorities any incident perceived as a threat or imminent danger to oneself or another person.    

Do you agree to these terms in order to proceed with the call?

Boys Town National Hotline:  1-800-448-3000

National Domestic Violence and Sexual Assault Hotline: 1-800-799-7233

Confidential Trafficking Resource Center Hotline: 1-888-373-7888

Omaha Resources:

WCA - (402) 345-7273

Omaha Police Department -  (402) 444-5600

Omaha FBI - (402) 493-8688

Project Harmony (402) 444-5636

Omaha Child Protective Service - (402) 595-3250

About the caller.

About the minor.

Digital and social media Details.

Minor's social media usernames:
Venmo / Paypal / Amazon

Intake notes.

Print screen prior to submitting form.