Peer Specialist Request Form Name:(required) Phone Number:(required) Email:(required) Best way to be contacted:(required) Email Phone How soon are you looking to meet with someone? Which type of Peer Specialist do you want to meet with?(required) Individual Peer Specialist Family Peer Specialist What is your (or your loved one's) diagnosis? Relationship to person with diagnosis (if not yourself)? Preferred days/times Do you have any preferences for you Peer Specialist: Male Female Older Younger Faith Based No preference Were you referred by someone?