Confidential Request for Gospel Shepherding
Anyone desiring Gospel Shepherding should complete the form below.

Please know we value your privacy. This form is confidential and will only be seen by the Pastoral team at Veritas.

Please be as detailed as possible. If your situation is urgent please email the church office at info@veritascr.church or if you are in an emergency situation, please call 911.

Name
Your answer
Email address
Your answer
Street Address
Your answer
City, State, Zip
Your answer
Phone Number
Your answer
Gender
Birthday
Your answer
Are you a member of Veritas Church?
Do you regularly attend Veritas Church?
Please state briefly why you are seeking counseling and what you hope to attain.
Your answer
Are you currently under the care of a psychiatrist, psychologist, or mental health counselor?
If yes, please give name, date, location, length of therapy, and briefly explain the nature of the problem for which you sought help?
Your answer
Are you currently taking prescribed medication for your mental health?
If yes, please explain.
Your answer
Are you in a Connection Group? Name of Leader?
Your answer
Have you talked with your Connection Group Leader about this issue?
Have you talked about this issue with another Pastor? If so, who and when?
Your answer
Submit
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