Screening Form

This form helps us understand your current situation so we can connect you with the most appropriate program or support. You are welcome to skip any questions you do not feel comfortable answering. If you would like assistance completing the form, a staff member can help.

IMPORTANT: If you feel that you and/or your children are not safe right now or are at risk of harm, please call 911 or the Crisis Line 1-800-353-2273 for immediate support.

WHAT HAPPENS NEXT – A Salmo Community Services’ staff member will contact you within 10 working days to speak about next steps. If we do not offer a service that fits your needs, we will work with you to identify possible referrals to other organizations that can support you. Your comfort, privacy, and safety are our priorities.

CONFIDENTIALITY STATEMENT: Information you share on this form is kept private and confidential within Salmo Community Services and is used only to help us determine how best to support you. We will not share your information without your permission, unless required by law—for example, if there is a concern about serious risk of harm to yourself, your children, or someone else. If you have questions about confidentiality, we are happy to explain.