WATA ATs Care Contact Form

We provide support services to help you and your staff on a FREE CONFIDENTIAL & NON-JUDGMENTAL basis.

Individual Form Fields for: (*denotes required fields)

Direct Patient Involvement: A critical incident in which the AT was directly involved. Examples: AT performed CPR on patient, spine boarded a patient, or has been diagnosed with cancer

Indirect Patient Involvement: A critical incident in which the AT is impacted, but not directly involved in the incident. Example: Athlete/Patient died in a car accident)

  COVID-19 Involvement
  Athletic Related
  Fatality
  Other (Please Elaborate)

(If you are someone requesting ATs Care services, please provide a brief background of why you are requesting services. This is not mandatory. If you are a CISM team member, please indicate whether or not services were rendered or declined, and how many ATs were impacted.)

  Male
  Female
  Prefer not to specify