CMRN Intranet

Request for Service Page
This page allows you to securely send us the information we need to contact a military client in need of our services. It eliminates the insecurity of sending personal information over email. You may still send us email at, but do not include any sensitive or personal client information within an email - use this form. You may send us a request to be added to our database, which contains a secure method of communication, if you wish to continue working with a client.
Counselor Information
Please provide your contact information below.

Client Information
At the very minimum, please provide at least a first name and a phone number or email address for us to contact the client.

Please provide a summary of the client's situation, the type of services they are seeking, and any special instructions.