Chat Registration:







The following is used for conversational purposes only and is optional.
First Name
 
Last Name
 
 
 
 
 
 
After this brief chat registration you will be able to chat directly with a problem gambling counselor. 
Reason for visit * 
Are you thinking of hurting yourself or someone else? * 

To enable Google Chat or SMS (text) communications please provide the following info:
Cellular Number:
 


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