OPS Peer Support Request

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***INFORMATION SHARED TO THIS FORM IS PROTECTED UNDER CONFIDENTIALITY LAWS***

If you are wanting to receive peer support from a trained peer supporter of the Overwatch Peer Support Program, please complete the form below. This registration form is checked daily by the Frontline Wellness Coordinator and you will be contacted within 24 hours for follow-up. Information provided in this form is protected information under confidentiality laws.

Overwatch Peer Support Program

Name *

Phone *

Department (This is to make sure you are not paired with someone in your department or neighboring city)

By checking a box below, I confirm that I am an active member of North Texas Law Enforcement or Fire/EMS.

(all LEO and Fire/EMS agency employees are eligible for assistance, including all ranks, departments, communications/dispatch, corrections and civilian employees)

Law Enforcement

Fire/EMS

Communications

Correction Officer

Federal/Other

Required

Would you like to speak with a male or female Peer Support Leader?

Male

Female

Clear selection

Submit

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