Small Group Facilitator Follow-up Form
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of small group
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of small group
How many people were present in the group?
Select the area(s) that anyone in your group need the Care Team to provide follow-up:
Hospitalization
Surgery/Medical Procedure
Illness
Bereavement / Loss of loved one
Birth or Adoption of a child
Homebound or on-going care needed
Prayer request requiring Care Team Follow-up
Other
If you select any of the areas above, provide the name(s), a brief description of the need, and any other relevant information that will assist the Care Team in following up appropriately.
Share if someone in the group decided to make a Next Step:
*
Is there anyone that you would recommend to be a future group facilitator? Please list the person's name and why.
Submit
Should be Empty: