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Soul Care Application
Your name
*
Last name
Email address
*
Phone number
Phone type
Mobile
Home
Work
Other
Birthdate
Date
Gender
Select…
Male
Female
Marital status
Select…
Single
Married
Widowed
Emergency Contact: Please type their name, your relationship to them, and their phone number
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Are you a Christian?
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Yes
No
Church Membership Status
*
Select…
Member
Non-Member
Interested in Membership
Are you currently in a Community Group?
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Yes
No
Would like more info
Please list the reason or reasons for seeking Soul Care with Living Stones. In order for Living Stones to provide the best possible care for you, please give a thorough description of your situation and when/how it started.
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Please rate the severity of your present concerns on the following scale.
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Select…
Somewhat severe
Moderately severe
Extremely Severe
Can you identify which area or areas of your life are being affected the most by the current concern or situation?
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If you have spoken to a pastor, deacon, or another church leader at Living Stones, please state their name.
Do you have a Living Stones Pastor or Soul Care provider in mind whom you would like to meet with?
Do we have your permission to share this information with the appropriate Soul Care provider to arrange for the best possible care?
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Yes
No
What do you hope to achieve through the Soul Care process? Briefly list two or three goals you have in mind.
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How would you describe yourself (personality traits, etc)?
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Family Soul Care: If applicable, what are the names and ages of the children involved?
Please select the days & times you are able to meet for Soul Care
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Monday AM
Monday PM
Tuesday AM
Tuesday PM
Wednesday AM
Wednesday PM
Thursday AM
Thursday PM
Sunday PM
By submitting this application, I fully understand that the ministry I receive is NOT professional licensed counseling in any form, but rather a spiritual guidance and prayer ministry that is biblically-based. I accept this ministry fully and completely.
*
Yes
No
Unsure
Submit
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