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Spiritual Care Request Form
Thank you! We look forward to arranging a time to talk!
First Name
Last Name
Email
Phone Number (optional)
How would you like us to reach you?
Please select an option
Phone call
Email
What are the best times of day to contact you?
Please select an option
Morning
Afternoon
Evening
Are you requesting spiritual direction or counsel?
Please select an option
Spiritual Direction
Spiritual Counsel
Do you prefer in person or virtual sessions?
Please select an option
In person
Virtual
Either is fine
Please say a little about what lead you to request spiritual care. You can say things like, “ I want to develop my interior life. I have struggles with addiction, or I want to add some spiritual practices to my life and don’t know how.” This form is confidential so please feel free to share as little or much as you like.
By submitting this form you are acknowledging awareness that the nature of direction and counsel through the church is relational and spiritual in nature and not the services of a licensed therapist.
I agree and acknowledge
I disagree
Thank you! We look forward to arranging a time to talk!
Submit
