Mentoring Form

Thank you for connecting with Bridge to Serenity, LLC for Peer-to-Peer Mentoring! This program is Bible-based support with practical tools that lead people on a healing journey of HOPE. To assist with making the most out of our time together, we kindly ask you to take a moment and fill out the following form. It is important as those ministering and receiving healing have on-going support. Our time together is designed to support you on your healing journey and give you practical tools for on-going wellness, but it does not replace other tools for your journey. 

Email *
Your Email *
Your Name *
Your Phone Number *
Your Physical Address *

What would you like to gain from our time together?

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Are there any areas of difficulty that you would like us to know about ahead of time? *

Who could we contact if you experience any difficulty with strong emotions or past trauma during our time together?  

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Please enter their name, contact information, and their relationship to you below.

Are you in regular contact with a counselor, life coach, spiritual director, or pastor?

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Required
Are you interested in attending a Trauma Healing Group? *

I understand that this is a Bible-based Peer-to-Peer Mentoring support and not a substitute for counseling, therapy, or a professional diagnosis.

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Type full name to confirm you understand and agree with the above. 
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