Request a Shield Alert - MindFreedom International (MFI)

If you have already registered for the MindFreedom Shield Program by submitting a Shield registration form through our website, you may use the form below to request a Shield Alert.

If you have not yet registered for the Shield, please click here to do so before filling out the form below.

Shield enrollee name*
First Last
Email address
Phone*
Preferred communication method*
- Phone
- Email
- No preference
Current location*
City State / Province / Region Country
Current location of enrollee's Shield representative (if applicable)
City State / Province / Region Country
Are you currently under legal guardianship?*
- Yes
- No
- Not sure
Are you currently under a court order?*
- Yes
- No
- Not sure
Which of the categories below best describes your current situation?*
Please briefly explain your current situation. If possible, include the names and contact information of any facilities, psychiatric personnel, and/or legal representatives involved.*

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