We'd love to connect.
If you are struggling emotionally or spiritually, we'd like to help as best we can. Please fill out this form and someone will be in contact with you as soon as we are able.
Name*
Email*
Phone*( ) -
Age*
Gender*
Are you a member of Richland Creek?* Yes No
Is this need for you individually, or for you and someone else?* Just for me Me and someone else
Please tell us about your problem, and describe what you have done about it so far.*
How can we best help you?*
Is there anything else we should know?*
On a scale of 1-10, what is your current stress level?* 1 2 3 4 5 6 7 8 9 10
Feeling unsafe?
If you would not feel safe having a counselor contact you by phone or e-mail, after submitting this form please e-mail mikegreene@richlandcreek.com and let us know how can best get in touch with you (particular time of day, through friend or relative, etc.)
