Request for Service

First Name

Last Name

Phone

Address

If you are in immediate danger, please call 911 If you need immediate medical attention, please go to your local hospital If you are in crisis or would like to talk to someone right away, please call The Helpline at 1-800-494-8100. Day One offices can be reached directly at 401-421-4100 Monday through Friday 8am-5pm

What is the best and safest way to contact you? PhoneEmailMail

May we identify ourselves as Day One when we contact you? YesNo

What is the best time to contact you?

Any other specific contact instructions/limitations?

Additional information / questions

Request for Service

There is hope in the action of healing.

We can connect you with the support you need.

Call Day One

Request For Services

Set up services:

Clinical: (401) 421-4100 x121

Children: (401) 421-4100 x119, cacreferrals@dayoneri.org

Other Forms: