Redeemer Church

Name *

First Name

Last Name

Phone *

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Type of counseling needed *

Individual

Marriage

Premarital

Family

Other

Urgency *

Hoping to talk within the next week

Flexible - within the next month

Just exploring options

Preferred availability *

Weekday mornings

Weekday afternoons

Weekday evenings

Weekend

Preferred Contact Method *

Phone

Email

Text

Agreement *

I understand that counseling provided by Redeemer Hope Center is provided by trained volunteers, not licensed professional counselors, and is based on the Bible as God's authoritative Word.

Yes, I understand and agree