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Behavioral Health

Crisis Response Permission & Consent

Use this form to request crisis response services and tell us who we may talk with while coordinating care. If you are in immediate danger, call 911.

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Phone

This field is for validation purposes and should be left unchanged.

If You Are Experiencing a Crisis or Life-Threatening Emergency Call 911 or go to the nearest emergency room (ER). Mental Health Crisis or Emergency Call 208-994-5537 for local crisis assistance, or call/text 988 for the 988 Suicide & Crisis Lifeline. You can also go to the nearest emergency room (ER). If you are in immediate danger or concerned about your safety, call 911 or go to the nearest emergency room (ER).

Crisis Response and Consent Request Form

Client Name(Required)

First Last

Date of Birth(Required)

Parent/Guardian (if applicable)

Phone(Required)

Email(Required)

Permission for Crisis Response Services

I give permission for Ignite Idaho Family Resource Center and its authorized crisis response staff to provide crisis support services to me/my child as appropriate. Crisis services may include:

Crisis screening and assessment

Safety planning and stabilization support

Coordination with behavioral health providers

Coordination with school personnel, when applicable

Contact with parent/guardian or identified support person

Connection/referral to community resources and follow-up services

Coordination with emergency medical services, law enforcement, hospital/emergency department, or other emergency/crisis providers when necessary for safety

Follow-up contact after the crisis

Transportation assistance/coordination, when appropriate and authorized

Other

Permission to Communicate

For purposes of coordinating the immediate crisis response, I authorize Ignite Idaho to communicate with:

Parent/Guardian

Emergency Contact

School

Counselor/Behavioral Health Provider

Medical Provider/Hospital

Probation/Court Personnel

Other

Emergency/Support Contact(Required)

First Last

Phone(Required)

Acknowledgment

I understand that crisis response services are intended to assess immediate needs, support safety and stabilization, and connect individuals with appropriate services. Crisis response does not guarantee a specific outcome or replace emergency medical care. I understand that information will generally be kept confidential as required by law. However, Ignite Idaho may disclose information without authorization when required or permitted by law, including situations involving an immediate safety concern, suspected abuse or neglect, or another mandatory reporting obligation. I understand that I may revoke this permission in writing, except to the extent that action has already been taken based upon it.(Required)

Yes

What happens next


Send the consent form.

Our crisis response team reviews it and reaches out.

You can revoke this permission in writing at any time.

Prefer to talk?

Call 208-994-5537 or email ignite@igniteidahofrc.org.

Monday-Friday 9am-5pm
Additional times by appointment
106 E Park Street, Suite 227, McCall

If You Are Experiencing a Crisis

Life-Threatening Emergency
Call 911 or go to the nearest emergency room (ER).

Mental Health Crisis or Emergency
Call 208-994-5537 for local crisis assistance, or call/text 988 for the 988 Suicide & Crisis Lifeline. You can also go to the nearest emergency room (ER).

If you are in immediate danger or concerned about your safety, call 911 or go to the nearest emergency room (ER).

What you share here goes only to Ignite Idaho staff. We keep it confidential as the law requires.

Not sure what you need? Ask us.

Tell us what's going on and we'll connect you with the right resource, in-house or through one of our partners. There's no wrong way to reach out.

Connect with resources

208-994-5537

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Ignite Idaho

Family Resource Center
Strengthening Families. Strengthening Communities.

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Contact

208-994-5537
ignite@igniteidahofrc.org
106 E Park Street, Suite 227
McCall, ID 83638

Office Hours

Monday-Friday 9am-5pm
Additional times by appointment

If You Are Experiencing a Crisis

Life-Threatening Emergency
Call 911 or go to the nearest emergency room (ER).

Mental Health Crisis or Emergency
Call 208-994-5537 for local crisis assistance, or call/text 988 for the 988 Suicide & Crisis Lifeline. You can also go to the nearest emergency room (ER).

If you are in immediate danger or concerned about your safety, call 911 or go to the nearest emergency room (ER).

Funding for this was made possible in part by grant number G28RH46297 from the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA). The views expressed do not reflect the official policies of Central District Health or HRSA, nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.