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Care Assessment
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Work Entry
First Name
First Name cannot contain special characters such as quotes, parentheses, etc.
First Name cannot contain emojis or special fonts.
First Name is required.
Last Name
Last Name cannot contain special characters such as quotes, parentheses, etc.
Last Name cannot contain emojis or special fonts.
Last Name is required.
Email
Email address is not valid
Email is required.
Mobile Phone
Mobile Phone is required.
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Which campus do you attend?
Southwest
Bee Cave
Dripping Springs
Highland Lakes
I do not attend
Which campus do you attend? is required.
Describe why you reached out to our Care Team and include context that would be helpful for us to know about your situation.
Describe why you reached out to our Care Team and include context that would be helpful for us to know about your situation. is required.
Have you met with another Pastor or counselor to discuss your situation?
No
Yes
Have you met with another Pastor or counselor to discuss your situation? is required.
If you are requesting to meet with Phillip, Michael, Sunni, or Cheryl specifically, indicate why below
None
I have met with him/her previously
I was referred to him/her by someone
I am not requesting to meet with a specific person
Other
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