Care-on-Call Intake Form - East Coast Church

First and Last Name of Caller *

Phone number *

Email address of caller *

Can we text the caller at the above number? *

Location the caller normally attends *

Was this a walk-in or phone call? *

Walk-in

Phone Call

How Did You Help? *

Provide as much detail as possible as to what you discussed, what you suggested, what you believed in prayer with them for.

Is follow up care needed? What else can we assist them with? *

Did you invite them to church? *