SEEKING A RECOMMENDATION FOR A MENTAL HEALTH PROFESSIONAL (Confidential)
This is a form to request a recommendation for a Christian Mental Health Professional. A member from the Caring Together team from CrossCulture will process this form.
Name *
Gender
Clear selection
Age *
If you are under 18, we will need the consent of your guardian for the recommendation. Please provide the name and contact of at least one parent/guardian for us to get in touch with.
Location/Suburb of Residence
This can help with a better recommendation of professional help near you.
Preferred Mode of Contact *
Please provide at least one mode of contact (e.g. email, phone)
What concerns are you seeking help for?
Would you like to speak to a pastor?
Clear selection
Any other comments?
Agreement of Consent *
Required
Submit
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