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CARE TEAM REQUEST/REFERRAL FORM
Most of us can use a little help and support from time to time. Use this form to request contact from UU Mt Airy's Pastoral Care Team for yourself, or to refer someone else. A team member will respond to your request as soon as possible. Your request will be held in confidence.
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Email
*
Your email
Your name and contact information:
*
Your answer
How would you like to be contacted?
*
Phone
Email
Other (please specify)
Required
Best time of day to contact you:
*
Morning
Afternoon
Evening
Anytime
I wish to be contacted by the minister only.
*
Yes
No. Either the minister or a Care Team volunteer is fine.
If you are referring someone else, please list their name and contact information:
*
Your answer
If you are referring someone else, have they given their consent to be contacted? The Care Team will only contact those who give consent.
*
Yes
No
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