Crisis Support And Prayer Form

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If you are seeking care, please fill out our Care Form and someone will contact you shortly. Please be patient with us as we are a group of volunteers. In case of an emergency, you can contact us via email at dannyhah@gmail.com or send a text or leave a voicemail at 917-853-2162. Thank you!

Name *

Email *

Phone number *

Are you currently attending All Nations Harvest Church?
*

Yes

Area(s) of focus? (check any that apply)
*

Anger Management

Anxiety/Stress Management

Calling discovery and vocational discernment

Chemical Dependency

Chronic Illness/Health/Medical Challenges

Conflict resolution/reconciliation

Dating

Depression

Disordered Eating

Education/School

Family of origin issues

Financial Struggles

Forgiveness

Grief/loss

Housing

Identity/Self Image

Infidelity/Relationship restoration

Inner Healing

Interracial/Intercultural Relationships

Leadership Development

Life Coaching

Life Transitions

Marriage

Parenting

Pastoral Counseling

Physical Healing

Pornography

Premarital Issues

Relationships

Salvation/Relationship with Jesus

Self Harm

Sexual Integrity

Spiritual Formation and Direction

Trauma/Abuse

Unwanted same-sex attraction

Vocation/Employment

I do not wish to disclose

Other

Required

Additional information you would like to supply?

Submit

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