Prototype only. Do not enter real identifying or sensitive information.
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Accessibility

These display choices stay in this browser. Read Aloud uses the device’s built-in voice and does not send page text elsewhere.

Optional Device-Local Profile

Support Intake

Organize what kind of help may be useful before contacting an advocate, agency, or other professional.

Prototype limits: Do not enter names, addresses, phone numbers, case numbers, or real identifying or sensitive details. The form is not sent or matched with a provider. It stays unsaved unless you explicitly choose the device-local save option at the end.
Is Immediate Help Needed?

Choose the closest answer. This does not calculate risk.

Who Is Looking For Support?
What Support Might Help?

Select any that apply. These choices are not a diagnosis or eligibility decision.

Practical Considerations

These prompts can help a professional understand accommodations or immediate barriers.

Cove does not request contact information. Confirm actual contact safety directly with the provider.