Mission of Reconciliation

Restoration Journey

In partnership with USA Missionaries

This confidential form gives us an opportunity to understand your story, what you are walking through, and where you are seeking healing, freedom, reconciliation, or restoration. You do not need to have everything figured out. Simply answer as openly as you are comfortable, and we will use what you share to prayerfully consider how we can best come alongside you.

Take as long as you need. Your answers save on this device as you go, so you can stop and come back. Nothing is sent until you choose to send it. If you would rather talk something through in person than write it here, leave it blank — that is completely okay.

New here? Read about Mission of Reconciliation.

Welcome

A few things to know before you begin, and how we can reach you.

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I understand what I share here will be kept confidential and read only by those who will come alongside me. *Only the people coming alongside you, and those who oversee this ministry, will read what you share.I am choosing to share this freely, and I understand the limits of confidentiality. *There are limits to confidentiality when someone is in immediate danger, when abuse is happening now, or when the law requires us to report.I understand this is spiritual care and does not replace emergency, medical, or professional care. *Walking with someone spiritually is not a replacement for emergency help, medical care, or professional care.

Is there immediate danger, current abuse, or thoughts of ending your life right now? *

If this is happening right now, please stop and contact local emergency help. In the United States you can also call or text 988.

YesNoNot sure

What name would you like us to use?Email *This is how we will reach out to you.Phone (optional)