Thank you for taking the time to complete this intake form. We understand that discussing your child’s gambling experience may be difficult, and we appreciate your trust in sharing this information.

A member of our team will review your responses. Based on your answers, if we determine that next steps are warranted, a member of our team will contact you within 3–5 business days to discuss potential next steps. If we require additional information, we may contact you sooner.

We are committed to holding online gambling platforms accountable — and to supporting families like yours.