Counseling Request

Counseling

Name

First NameLast Name

Email

example@example.com - optional only if you want a response

Phone Number

optionalFormat: (000) 000-0000.

Preferred Contact Methodi

Is it okay to leave a voice message or text

General reason for request

Briwfly descibe how we may help you

Do not include highly provate or medical details0/100

Prefrred Meeting Method

How soon would like to be contacted?

Are you a member or attendee of Glen Burnie UMC?

Would you like someone to contact

Consent checkbox: I understand that submitting this form is a request to be contacted and does not confirm an appointment.

Your request will be treated with care and shared only with the appropriate pastoral staff. Please do not include highly sensitive personal, medical, legal, or financial information in this form. This service is pastoral support and is not a substitute for professional mental-health or medical treatment. If you or someone else is in immediate danger, call 911. For a mental-health or suicide crisis, call or text 988.