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Life Connections provides free counseling and support services to survivors of crime in Dallas, Denton, Collin and Tarrant counties. By checking “yes” you certify that you: 
 Are a survivor of crime that occurred in Collin, Dallas, Denton, Ellis, Erath, Hood, Hunt, Johnson, Kaufman,       Navarro, Palo Pinto, Parker, Rockwall, Somervell, Tarrant, and Wise Counties and you reside in Texas 
         OR
Are a resident of Collin, Dallas, Denton, Ellis, Erath, Hood, Hunt, Johnson, Kaufman, Navarro, Palo Pinto, Parker, Rockwall, Somervell, Tarrant, and Wise Counties even if the crime occurred elsewhere. 
Today's Date
What is your Contact Information?
What is your date of birth?
Your Gender: 
Your Race/Ethnicity:
Do any of these options apply to you?
Types of Victimization: (select all that are applicable to you in seeking services)
Who is your emergency contact?
What services are you seeking?
When is the best time to contact you by phone? 

Thank you for your interest in our services, a member of our team will reach out to you within two business days to schedule an initial appointment. 
 
Life Connections does not provide emergency or crisis services. If you are in need of immediate help, please call 911 or contact one of the following organizations: 
National Suicide Prevention Line: 988 
Dallas County Mental Health Crisis Line: 866-260-8000
Denton County Mental health Crisis Line: 800-762-0157
Collin County Mental Health Crisis Line: 877-422-5939
Tarrant County Mental Health Crisis Line: 800-866-2465
National Domestic Violence Crisis Line:800-799-SAFE (7233) 

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