[Imported Form] Vista Help FormThere are times in all of our lives when we need to reach out for help. Being willing to say, "I need help" is sometimes one of the most brave things that we can do. You can use this form to let someone on our team know that you are in need of help of some kind at this time.

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Name
First Name
Last Name
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Your Name* This field is required.
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Email
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Phone* This field is required.
Area Code
Phone Number
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Please choose your gender
Male
Female
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What type of help are you needing at this time?* This field is required.
Please Select
Please Select
Financial Assistance
Mental Health Resources
Relational Help (Marriage, Divorce, Affair, etc.)
Addiction/Chemical Dependency
Other
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Explain "Other":
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Tell us a little bit about what's going on:* This field is required.
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If your request is financial in nature, please upload a copy of your photo ID.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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If your request is financial in nature, please upload a copy of the bill or housing agreement you need assistance with.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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