Pastoral Care & Support

Pastoral Care & Support

The Life Church is committed to helping people grow and flourish in every area of their life by providing care and support through Life Groups, and our Pastoral Care ministries. Please tell us just a bit more about you and your current need, so we can provide the best care and support possible.
Please note that in filling out this form you give The Life Church Memphis permission to share your information with appropriate staff members. All information will be otherwise kept confidential.
Your Name *

First Name Last Name
Your Email *
example@example.com
Your Phone Number *

Area Code Phone Number

Your Address *

Hospital Visit
Name of the person in Hospital: *
Name of the Hospital: *
Hospital Room Number *
Why is the person requesting a visit in the hospital? *
(Accident, procedure etc.)
What is the current status of the person requesting visit? *
(Critical, Stable etc.)

Parenting
Your Name *

First Name Last Name
Name of Parent/ Legal Guardian *

First Name Last Name
Relation to the Child *
Child's Name *

First Name Last Name
Child's Date of Birth *

Month Day Year
Date
Child's Gender *

Female Male
Who does the child live with? *
(Parents, Step Parents, Grandparents, Siblings, etc.)
Does the child attend school? *

Yes No
If yes, what grade/ year? *

Parenting

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Tell us a little about your child. Does he/she have any interests or hobbies? What arehis/her positive characteristics? *
What is the primary reason for your concern? *
Does your child share your concerns? Why or why not? *
Is there a concern of abuse or a history of abuse, either physical, mental, emotional, sexual or other? *

Yes No
If yes, please explain. *

Pre-Marital Coaching
Thank you for your interest in Pre-Marital Coaching! Please click "Submit" below so we can receive your initial information.

Your next step will be to visit the "Weddings at The Life Church" webpage, read over the information there and register for Pre-Marital counseling via the link on that page.

If there are any questions in the meantime, please don't hestiate to reach out to our Wedding Coordinator, Ashley Pier. Congratulations on the engagement and we look forward to hearing from you soon!

Marriage Coaching
Please describe the current status of your Marriage: *
Are you experiencing physical abuses? *

Yes No
Are there any anger issues? *

Yes No
Are there any issues, which you feel may require professional mental health attention? *

Yes No
Are both you and your spouse willing to participate in marriage coaching? *

Yes No
Spouse's Name

First Name Last Name
Spouse's Email
example@example.com
Spouse's Phone Number

Area Code Phone Number
What days and times during the week are best for you both to meet? *

Counseling/ Coaching History
Have you received counseling/coaching before? *

Yes No
If yes, who facilitated the counseling/coaching? *
When did the coaching take place? *
What were the results?
By filling out this form and clicking "Submit" below, I give The Life Church Memphis permission to share my information with appropriate staff members. I recognize that all information will be otherwise kept confidential. *

I acknowledge the above
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Life Coaching