Request Entry

Anyone desiring Gospel Shepherding is required to complete the form below.

Please know we value your privacy. This form is confidential and will only be seen by the Pastoral / Adult Ministry Team at Veritas.

Forms are reviewed weekly. If yours is an emergency situation, please call a health care professional or 911.

First Name

Last Name

Phone Number

Campus

Address

Birthdate

Gender

Martial Status

Do you regularly attend Veritas Church?

Please state why you are seeking Gospel Shepherding and what you hope to attain.

Are you currently under the care of a psychiatrist, psychologist, or mental health professional?

If yes, please give their name, date(s), location, length of therapy. Also explain the nature of the issue for which you sought help and the counsel you were given.

Are you currently taking prescribed medication for your mental health?

If yes, please explain.

Are you in a Connection Group? Name of Leader?

Have you talked with your Connection Group Leader about this issue?

If yes, what guidance were you given?

Have you talked about this issue with a Pastor?

If yes, what guidance were you given?

Please describe your relationship with God through Christ. Check as many as apply.

Close & intimate Formerly close - distant now Growing Plateaued Uncertian Non-existent- for as long as I can remember

If you are married, how long have you been married?

We're you previously married?

If you have children, how many do you have?