Services Inquiry Form
Thank you for reaching out!
If you are experiencing a medical or mental health emergency, please call 911 or go to the nearest emergency room. If you are in need of immediate emotional support or are experiencing thoughts of suicide, please call the National Suicide Prevention Lifeline at 988. OUR HOUSE New York City will be offering grief support groups beginning in October 2025.
Name
First Name
Last Name
Your pronouns
Have you experienced the death of someone close?
Yes
No
If yes, please indicate who that person was in your life?
Are you contacting us on behalf of someone else?
No
Yes, for a client, friend, or family member
Yes, for a child(ren)
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
We have updated our intake process. To be redirected to the new intake form, please visit our website at www.ourhouse-grief.org/nyc
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