Critical Incident Stress Management

Crisis Referral Form

A critical incident is a traumatic event which can cause strong physical, emotional, mental, and spiritual reactions which can affect an individual’s ability to cope with the immediate and after effects.

A critical incident refers typically to an urgent emergency-type situation that occurs outside the range of usual human experiences. These incidences can occur at any given moment or in any given situation, such as a home, institution, or community, and any time of the day or at any point in an individual’s life.

CISM services are available to help assess, organize, manage, and facilitate the typical or a-typical response that happen in the event of a crisis. The services may be provided during and/or immediately following the crisis as well as afterward if new elements arise or resurface following the initial crisis.

  • Date Format: MM slash DD slash YYYY
  • Contact Information

  • Crisis Situation

    Check and give any additional information possible, to what critical incident best indicates your reason for request of CISM services
  • Categories of Effect

    Check known categories of effect.