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.
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?
Grief & Loss
Suicidal Thoughts/Ideation (for immediate help, call Lifeline - 13 11 14)
Would you like to speak to a pastor?
Any other comments?
Agreement of Consent
I consent to the release of my personal information to CrossCulture's Caring Together Team for the purpose of seeking a recommendation for a Christian Mental Health Professional
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This form was created inside of CrossCulture Church of Christ Inc.