free coaching and prayer support enquiry form

Thank you for reaching out to us at this difficult time. We would love to listen to and encourage you and pray with you.*

To help us use our time with you as well as possible, could you please provide us with your responses to the following questions. All information provided to us will remain strictly confidential. (It will typically take between 5-10 minutes to complete this form.)

*There are some rare situations in which this service will not be appropriate, however, if this is the case, we will do our best to give you other recommendations.

Email(Required)

Phone(Required)

State(Required)

How would you describe your present faith situation?(Required)

If you are a member of (or regularly attend) a church, please advise us of the denomination of your church?

If you selected other/independent church in the previous question, please specify below.

How did you come to know about this free PeaceWiseHelp coaching service?(Required)

In what context has the conflict occurred?(Required)

Besides yourself – how many people are directly involved in this conflict?(Required)

How long has the conflict been going for?(Required)

Do the other people involved in this conflict profess to be Christian believers?(Required)

Briefly describe the situation you would like to discuss with us. Please include any relevant information which you believe would be helpful for us to know.(Required)

How long have you been trying to deal with this conflict? Please tell us briefly any relevant information.(Required)

Are there any special considerations affecting this conflict which would be helpful for us to know? If so, please provide as much detail as possible. (e.g. Are there cultural sensitivities which might play a part?)

Is there any other information you believe would be helpful for us to know?

complimentary coaching and prayer support enquiry form