Confidential Request for Help with Healing
First Name
Age
State
e-mail address (feel free to create a new e-mail account using your correct first name but make up the rest for your protection If you choose to do this, please make the account before you hit the submit button at the bottom of this page. Hotmail and Yahoo both offer free accounts.)
Would you share your story as much as you are able.
What are your biggest concerns right now?
In order to help us know where to start, would you share about your relationship with the Lord?
Please check any of these things that are or have been a part of your life. They will help us choose the right helper for you.
Could we try to help you find someone in your area to help you? Would you list two or three cities that are close enough for you to travel to for help.
We don't contact these people, we just send you the contact information so you can decide what you want to do.
eating disorder
Dissociative Identity Disorder
self-harm
chronic depression
abortion
suicidal thoughts
a panic disorder
Borderline Personality Disorder
hearing voices