Online Intake Form

Please complete the form below to seek our services (counseling, advocacy, therapy). Please note that Abuse Resource Network & Therapy services are voluntary and should be initiated by the person seeking services, not by a loved one or third party.
Once you complete the form below, we will be in touch within five (5) business days. Please be sure to include a phone number and/or email address where you can be safely reached. Please be sure to check your voicemail and/or spam/junk mail folder (for email correspondences). If you have not heard from a member of our team within five business days of submitting this form, or if you have safety concerns, please contact us at info@arn-therapy.org or 1.701.683.5061. Thank you!

I have read and understand this intake agreement: *

Abuse Resource Network & Therapy offers services to survivors of domestic violence & sexual assault in Ransom & Sargent Counties in North Dakota. Please fill out the entire form, including a safe phone number or email address. Please be sure that your voicemail is set-up and/or that your email is working so that we can successfully and safely reach you. Please note that our number will show up "Blocked" or "Restricted" when we call you.

In the comment box, please write which service(s) you would like to receive.
- Therapy, Legal Advocacy (assistance with Protection Order, advocating between you & Law Enforcement), Victim/Witness Info, Safety Planning, Counseling, Financial Advocacy, etc.

If you send an inquiry and it is out of our scope (Domestic Violence & Sexual Assault), we will help point you in the right direction.

All services are free and confidential.

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Safe email and/or Safe number *

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