• 313-470-1860
  • admin@safewellnesscenter.org
  • Dearborn, Michigan

Please fill out the form from your corresponding agency

Crisis Response Forms

School Crisis Referral Form

Behavioral Health & Student Support Referral

For Use by School Counselors, Administrators, and School Staff

Form Available for Download Here

Fill Out Form Here >

Hospital Crisis Referral Form

Hospital Behavioral Health Discharge Referral Form

Community Crisis Follow-Up Referral

For Use by Emergency Department Staff – ON HOLD

LEARN MORE >

Police Crisis Referral Form

Behavioral Health Crisis Diversion

For Use by Law Enforcement Officers

LEARN MORE >