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MiSecondChance Solutions
Client Intake Form

Thank you for choosing MiSecondChance Solutions. Our mission is to provide supportive services, advocacy, mentorship, and re-entry assistance to individuals and families navigating life transitions, mental health challenges, justice involvement, and personal growth.

"This is bigger than a second chance... it's a restart."
Client Information
Referral Information
Service Needs
Client Goals
Education & Employment
Support Systems
Mental Health & Wellness
Consent & Acknowledgement

I understand that MiSecondChance Solutions provides supportive and advocacy-based services intended to assist individuals and families in achieving personal, educational, and professional goals. I understand that services are collaborative and voluntary.

Your intake form has been submitted successfully. A member of the MiSecondChance Solutions team will be in touch with you shortly. Thank you for taking this step.
MiSecondChance Solutions
Empowering individuals. Restoring dignity. Rebuilding lives.
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