Important Information

Emergency Situations

If you are in immediate danger, please call 911 or the National Domestic Violence Hotline at 1-800-799-7233. We are not an emergency response service.

What We Provide

Sisterhood of Rahma offers community support, referrals, advocacy assistance, and faith-based resources. We do not provide medical advice or mental health treatment.

No Professional Relationship

Submitting this form does not create an attorney-client, doctor-patient, or therapist-client relationship.

Privacy & Confidentiality

We treat all information with care and confidentiality. Information is shared only within our support team or with trusted partners when necessary to assist you, and only with your consent—unless disclosure is required by law (such as when there is risk of serious harm).

Third-Party Referrals

When we refer you to other organizations or professionals, we do not control or guarantee their services. Participation is voluntary and at your discretion.

I acknowledge that I have read and understand the above information and consent to receive support from Sisterhood of Rahma.

Sisterhood of Rahma

Support Intake Form

Sisterhood of Rahma exists to support women with care, dignity, and confidentiality. The information you share helps us understand how to best support you. Your responses are private and will only be shared within our support team or trusted partners when necessary to assist you.

I consent to share this information for the purpose of receiving support.

Basic Information

First Name *

Preferred Name

Age Range *

Preferred Language *

City

State

Preferred Contact Method *

Phone

Is it safe to contact you at the information provided?Do not leave voicemail/text without permission

Religious & Cultural Considerations

Are faith-based resources important to you?

Would you like support that includes:

DuʿāʾIslamic guidanceReferral to an imam or female scholar

Any cultural or religious considerations we should be aware of?

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Safety Assessment

Important: You are not required to answer any question that feels unsafe or uncomfortable.

Are you currently in immediate danger?

Do you feel safe in your current living situation?

Would you like help creating a safety plan?

Legal & Advocacy Needs

Have you already spoken with a lawyer or advocate?

Are there upcoming deadlines or court dates?

Are you seeking:

Legal informationReferral to legal aidHelp understanding documentsAdvocacy support

Practical Support Needs

Grocery assistance / meal supportTransportation assistanceChildcare referralsMedical or mental health referralsTranslation or interpretation supportCase management / follow-up support

Availability & Capacity

Best days/times to reach you:

Preferred method of follow-up:

Do you have urgent needs within the next 72 hours?

How Did You Hear About Sisterhood of Rahma?

Thank you for trusting Sisterhood of Rahma. You are not alone, and we will do our best to walk with you through this with care and respect. May Allah grant you ease, protection, and relief.

I confirm the information shared is true to the best of my knowledge.