1 Peter 5:7 "Give all your worries and cares to God, for he cares about you" (The Apostle Peter) Help Request Form Let us know what you're looking for by answering the following questions. We will be in touch shortly. Any information you provide will be held in accordance with our confidentiality policy. Name First Last Email* Phone*Would you prefer to meet with...* Carson Vogt, MA, RCC (Chilliwack) Jelisa Penner, MA, CCC (Chilliwack) Samantha Henry, MA (Surrey & New West) Andrea Hendy, MA, RCC (Langley) Lisa De Vries, MA, CCC (Chilliwack) The first available clinician Would you prefer to attend appointments in the...* Select All Daytime Afternoon Evening Please note: Practitioner availability variesAre you looking for counselling for... Teens (Offered by Carson Vogt, Samantha Henry, Jelisa Penner) Adults (Offered by all Counsellors) Couples (Offered by Lisa De Vries & Andrea Hendy) What are your main goals?* Healing from Trauma Freedom from Anxiety &/or Depression Relational Improvements Freedom from Habits or Addictions Optimal Functioning Briefly describe your reason for seeking help.Do you prefer to be contacted by...* Phone Call Text Message Email How did you hear about Mercy Seat Ministry?