THE TRIAGE ROOM™Ministerial Consultation & Services Interest Form. Assess | Stabilize

THE TRIAGE ROOM™

Ministerial Consultation & Services Interest Form.

Assess | Stabilize | Treat
SECTION 1 – About The Triage Room™
The Triage Room™ provides structured leadership and ministry consulting grounded in the

Assess | Stabilize | Treat framework.

Led by:Dr. Jason D. Green, Ed.D.
Board Certified & Licensed Christian Counselor (NACC)
Board Certified & Licensed Chaplain
San Diego Black Chaplains Association
Chancellor, Man of War Ministry School of Seminary & Chaplaincy
Recipient, Honorary Doctorate in Christian Counseling
Ordained Apostle & Prophet

Professional Expertise Includes:

Crisis Intervention & Stabilization
Trauma-Informed Leadership Systems
Organizational Recalibration
Executive Ministry Advisory
Christian Counseling Frameworks
Chaplaincy Training & Certification
Conflict Mediation & Resolution
Ministerial Identity & Governance Strategy
Church / Ministry Name:
Name

First NameLast Name
Title/Role:
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Church Website (if applicable):
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
1–56–1011–2526+Other
Estimated Annual Church Budget Range (Optional):
Denomination / Affiliation (if applicable):

SECTION 6 – Timeline
Immediately (Crisis Level)Within 30 DaysWithin 3 MonthsExploring for Future Planning

SECTION 7 – Confidentiality Acknowledgment
All inquiries are treated with professional discretion. Submission of this form does not create a therapeutic or legal relationship but initiates consultation review.

Information shared will not be distributed outside The Triage Room™ without written consent, except where required by law.

SECTION 8 – Agreement
I am authorized to inquire on behalf of this ministry.I understand services are subject to consultation and formal agreement.I understand intellectual property of The Triage Room™ is protected.
Name*

First NameLast Name
Title/Position*
Date*

MonthDayYear
Date
Signature*

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SECTION 2 – Reason for Inquiry