You do not have to carry it alone.

Reach out regarding confidential care, leadership coaching, church consulting, speaking, resources, or partnership.

How can we serve?

This secure pre-intake helps determine whether biblical counseling or pastoral care may be an appropriate next step. Submission does not establish a counseling relationship. If care is offered, you will receive a separate service agreement and informed-consent materials before counseling begins.

Please protect your privacy

Share only a brief description. Do not include diagnoses, medical records, abuse narratives, names of third parties, or other highly sensitive details here.

For emergencies: This form is not monitored continuously and is not an emergency service. If anyone is in immediate danger, call 911 or local emergency services. In the U.S., call or text 988 for the Suicide & Crisis Lifeline.

Confidentiality notice: Information is kept private to the extent permitted by applicable law and ministry policy. Confidentiality is not absolute and may be limited when disclosure is required to protect someone from serious harm, report suspected abuse or neglect, comply with law or court process, or coordinate care with written authorization.

First nameLast name EmailPhone (optional) City and state / province / regionZIP or postal codeCountry Preferred contactType of care Brief reason for seeking care

Immediate safetyNo one is in immediate danger.Yes or unsure — show crisis guidance instead of submitting.

I am 18 or older and able to submit this inquiry for myself. A parent or legal guardian must contact the ministry regarding care for a minor. I understand this is explicitly Christian, Bible-centered care and I am open to practices such as prayer and Scripture discussion. Specific practices and my choices will be discussed before counseling begins. I have read the privacy and confidentiality notice, understand its limits, and consent to secure storage of this inquiry for follow-up.

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