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  • Support Group Request Form

    Bellis offers expert-led, peer-based emotional support. Please answer a few questions so our team can point you in the right direction. We are committed to serving as a uniquely compassionate source of support. All information is confidential and will never be shared. We'll respond ASAP, but please know responses are not monitored 24 hours a day.
  • If you need a listening ear before our next meeting, the Stronger Together Support Line is available for you. Feel free to call or text anytime at 833-4BELLIS (833-423-5547) - a trained team member will be ready to pick up the call or respond promptly.

  • General Information Form

    Thank you for your willingness to complete the following general information questions. You can choose to not answer questions you do not want to answer and/or stop at any time. We will protect all information by keeping all forms anonymous and safely storing the responses. If you have questions, please contact Vanessa@mybellis.org.
  • Adverse Childhood Experiences (ACEs)

    The next set of questions are about events that happened during your childhood, defined as the first 18 years of your life. Your responses to all of these questions are confidential and will help Bellis gain a better understanding of challenges you may have faced earlier in life and provide context for your experiences as an adult.
  • While you were growing up, during the first 18 years of life:

  • Thank you for answering these questions. Your responses will help Bellis gain a better understanding of challenges you may have faced earlier in life and provide context for your experiences as an adult.This perspective can be especially helpful for healing.

    If you or someone you know is in immediate danger, please call 911. If you are having thoughts of suicide or self-harm, please call or text the National Suicide Prevention Lifeline at 988. When you call, text, or chat 988, you will be connected to trained counselors who will listen, provide support, and connect you to resources, if necessary.

    Please note: if your message to Bellis today describes that you are worried about your own safety due to thoughts of suicide or self-harm, Bellis may contact local emergency services to check on your welfare.

    Bellis operates a mobile messaging program subject to these Mobile Messaging Terms and Conditions.

    This Privacy Policy explains how Bellis collects, uses, and discloses personal information about our customers, prospective customers, and visitors to our website.

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