Halltown Church - Contact for CM

Contact Information Form

First Name

Last Name

Birthdate

Are You Under the Age of 18?

Yes

Phone Number

Parent/Legal Guardian

Preferred Way of Contact

Call

Text

How Can We Help?

I have questions about counseling.

I want to take steps to schedule counseling sessions.

Please know this is just a contact of interest form. We will contact you for next steps & scheduling.

***If this is an emergency or you are having suicidal thoughts/intent to harm others please call 911**