Interest Form
This form is to indicate interest in having the church sponsor counseling. If you or someone you know is in crisis, please contact the Suicide Prevention Lifeline at 988 or 1-800-273-TALK (8255), or dial 911 in case of emergency.
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Disclaimer: The information collected here is only available to the Coordinator of the Mental Health Program.
Name *
Email *
Phone number *
Will you be attending the bimonthly Mental Health Clinics? *
Please indicate the type of counseling you are interested in: *
Please indicate areas of concern: *
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