Confidential Request

Pastoral Care Card

Share as much or as little as you'd like — whatever helps us walk with you well.

Your information is confidential

This card is read only by our pastoral care team. We do not share what you tell us outside that team, except in rare cases where someone's safety is at risk or the law requires disclosure. Please share at your own comfort — a short message is enough to get started.

How to reach you

Name *Email *PhonePreferred contact methodBest time to reach you

About you

AgeMarital statusDo you attend The River?

Meeting

Who would you like to meet with?How soon do you need to be seen?

What's going on

Topics you'd like to talk about (check any that fit)

Grief / lossMarriage strugglesFamily conflictParentingAnxiety / depressionAddiction / recoveryHealth crisisJob / financesSpiritual doubtLonelinessForgiveness / past woundsDecision / directionOther

Briefly, what's going on?How long has this been going on? Any background that helps?Who's currently in your support system (family, friends, groups)?Have you sought help for this before? What was helpful or not?What are you hoping for from pastoral care?

Safety

Any concerns for your safety or someone else's?Details (optional)

If you or someone else is in immediate danger, please call 911 right now.

Anything we can be praying for?I understand this card is confidential to the pastoral care team and I'd like someone to reach out to me.

Your message will be sent to aprilmooi@yahoo.com.

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