Charlie Health Alumni Family Discord Interest Form
Hello CH Alumni families! We are so excited to build this Discord community with you! Alumni Discord is only intended for families who have clients that have been fully discharged from Charlie Health.

By joining you will not only have channels focused on community and support related to you and your family's mental health journey.

Please complete the following and you will receive the link to Discord in your email upon completion. The link to join Discord will expire after seven days.

Discord and this form will not be monitored 24/7. Participating in Charlie Health alumni family programming is 100% optional. You can leave the server at any time.

If you would like to rejoin or participate at a later date, simply email alumni@charliehealth.com and we will get you reconnected. See you there!

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First and Last Name  *
Your child/loved one's name used by Charlie Health *
I confirm that my loved one has been discharged from Charlie Health and is no longer in the Charlie Health IOP. *
Required
Email: (This is where we will send the Discord Server link) *
Are you currently an adolescent/teen (11-17) family member or young adult (18+) family member?  *
Discord User Name:

Please include your full user name. If you do not currently have a Discord user name, that is fine - please let us know you will be signing up for one.
 *
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