The Emotional Health ministry is designed to promote a spiritual and emotional healthy environment. We currently offer a variety of support groups that deal with various emotional and spiritual health issues. Please give your honest opinion to the following questions. Your answers to this assessment will be kept confidential and will help in finding the ideal fit for you in a support group. If you know the specific group you want to attend, please list the name of that group under "what type of support group are you interested in."

This assessment is somewhat of a lengthy assessment, with that in mind, you may want to complete this form from a computer rather than from a mobile device.

Name*

Email*

Phone Number*

Address*

Gender*

Male
Female

Select your age division.*

Emergency Contact Name*

Emergency Contact Number*

Marital Status*

Number of Children*

Are you a memer of the POA*

Yes
No

Small Group Specifics

What type of support group are you interested in?*

What do you expect this group to provide?*

How would you like to be different at the end of this group?*

Have you ever participated in a support group? If so what type?*

Are you willing to commit to being in all group sessions and on time?*

Yes
No

If you know, please tell us what group you are interested in?*

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