Get Support | Brian J. Clark Here to Help

🖋️First Name*

🖋️Last Name*

📧Email Address*

📱Phone Number (optional)

📍City & State*

🤝What are you reaching out for? (Check all that apply):*

Personal support or mentorship

Creative collaboration or opportunity

Mental health or recovery guidance

Business advice or project consulting

General encouragement / Just needed someone to hear me

Other (please describe below)

🗣️Tell us your story, your situation, or what you need help with:*

🔒 This is a safe space — is there anything else we should know (triggers, timing needs, preferred communication, etc.)?*

📆 How urgent is your situation?*

I need help as soon as possible

Within a week or two

I’m okay — just wanted to connect

✅ Consent & Confidentiality:*

I understand that my submission will be kept confidential and reviewed in good faith, but is not a substitute for professional crisis support.

⚖️ Confidentiality + Capacity Disclaimer*

All submissions are kept strictly confidential and are never shared outside the Brian J. Clark Organization. While we do our best to support as many people as possible, our resources are limited and we may not be able to respond to every request immediately. If this is an emergency or crisis situation, please contact professional or local emergency services immediately. — BY MARKING THIS SECTION YOU CONFIRM THAT YOU HAVE READ AND FULLY UNDERSTAND THE TERMS AND CONDITIONS.

⚖️ Liability Disclaimer*

The Brian J. Clark Organization is committed to providing heartfelt support, encouragement, and guidance based on lived experience and creative empowerment. However, we are not licensed therapists, medical professionals, or crisis counselors. The information, advice, and resources we share are not intended as a substitute for professional mental health, medical, legal, or financial services. By submitting this form, you acknowledge and agree that: Any support or guidance provided is offered in good faith but without guarantees of outcome. You are solely responsible for any decisions you make based on the information or communication received. In the case of an emergency, mental health crisis, or danger to yourself or others, you should contact 911 or a licensed professional immediately. By checking the box and submitting this form, you agree to hold Brian J. Clark and affiliated team members harmless from any liability resulting from your participation in this support process. — BY MARKING THIS SECTION YOU CONFIRM THAT YOU HAVE READ AND FULLY UNDERSTAND THE TERMS AND CONDITIONS.

HERE TO HELP

RESOURCES

SAMHSA’s National Helpline

Suicide & Crisis Lifeline

Disaster Distress Helpline

Let’s Connect!