EmailMeForm
Appointment Request
Should you request an appointment as a non-member please be advised that Co-Laborers appointments receive priority for scheduling. Should your request be urgent in matter please contact a licensed counselor, physician or adviser to address your immediate need.
*Scheduling is completed through email, be sure to check your email for updates. Please respond to emails to complete the process and finalize appointments.
Name
*
First
Last
Phone
*
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Email
*
Are you currently a member of Word of Restoration Int'l Church?
Yes
No
How often do you attend service?
Less than once a month
Once a month
Three times or more a month
Marital Status
Single
Married
Divorced
Widow
Select applicable category
Men's Concerns
Women's Concerns
Pre-Marital Counseling
Marriage Counseling
Spiritual Guidance
Other
Detailed Description of Request
If your request is for marital counseling has your spouse agreed to counseling?
Yes
No
Counseling Format
In-Person
Phone Call
Zoom