Pastoral Care Form — REAL LIFE CHURCH

Email

Age:

Male or Female:

Employer (including your position & length of employment):

Marital status:

Spouse's name & spouse's occupation:

Name(s) & age(s) of child(ren):

Have you ever been previously married?

If you answered yes to question above, to whom?

How would you describe your relationship with your parents?

Have you ever had a severe emotional upset? If so, please explain.

What is your problem (what brings you to pastoral care)?

What have you done about the problem? (please be thorough & specific)

What are your expectations from pastoral care/counseling?

Is there anything else Pastor Freddy T. should know before meeting?