Congratulations on taking the first step!

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Congratulations on taking the first step!

We are happy for the opportunity to connect with you and provide prayerful support. Please take a moment to fill out this form so we can better serve you. Your responses will not be shared with anyone other than those on our team assigned to help.

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Name (first and last) *

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What brings you to the counseling team? *

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Is there a particular counselor you would like to work with? (We can't guarantee you will work with a particular counselor but we do try our best to honor your request.)

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Additional comments and/or questions

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