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MI is ME

Intake Form

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Emergency Point of Contact Information:
Health care team of professionals
1 (844) 36HELP2
I consent to the following personal information being collected on my behalf by MI Mother's Keeper & its affiliates for the sole purpose of helping me to find mental wellness, employment, social service, medical, and other resources in order that I can change my current life circumstance for the better. I release and hold harmless MI Mother's Keeper & its affiliates from any future claims that may arise as a result of their intent to advocate on my behalf.