Counseling Request Form

Before completing the form, please read about Triad Life’s Support Counseling Ministry at

The information collected within this form will be used by Life Support Counseling Ministry team members to understand and respond to your request for support. All information is handled confidentially. Jodie Anker, director of the counseling ministry, will attempt to contact you typically within a few days to either schedule an appointment, inform you of the waiting list, and/or offer referral ideas for other counseling resources in the area.

You must be 18 years old or older to request counseling. Parents or legal guardians must request counseling for their children under 18 years old.

Please note, the Life Support Counseling Ministry is not staffed full-time or equipped to provide emergency care. If you or your loved one(s) are at risk for suicide or are otherwise vulnerable to physical violence of any kind, please call 911 or go to your nearest hospital emergency room.

Fill out my online form.
Phase 2 Shot of TBC B&W 17

Join us Sunday at

9:00am Traditional Worship
10:30am Contemporary Worship