Name and Surname:

Email Address:

Cellphone / Contact Number:

Gender:

Age:

Preferred Language:

Church attending:

Have you received ministry from a Sozo/SoulCare team in the past?

Where:

When:

With whom:

Why would you like to receive a SoulCare?

Who referred you to the SoulCare Ministry?

NB! Would you mind if someone of the opposite gender sits in on your session?

Are you currently receiving counselling?

If yes, with whom?

Do you use medication for depression?

Are you part of a cell group/ small group/ connect group?

Which Campus would you prefer your SoulCare session to be at?

Please indicate the times that you will be available for an appointment – give at least 3 options (for Schoemansville only evenings – Tuesday to Thursday):

Monday: 09:0018:00

Tuesday: 18:00

Wednesday: 09:0018:00

Thursday: 09:0018:00

Friday: 09:00

***Allow 3 hours for the appointment.

Please give us an indication of your availability over the next 8 weeks:

Any additional notes you want us to be aware of?

***Donation: We do not charge a consultation fee, but you are welcome to give a donation for SoulCare. You can donate either by means of an EFT (Doxa Deo; ABSA Bank 4074057952; Reference: BLSoulCare+Name) or at our info desk during one of our Sunday services.