Care Request Form

The Care Team is a caregiving ministry of Church of the City New York. The purpose of this ministry is to provide spiritual care, support, encouragement, and referral services in a safe and confidential manner. Support is on a short-term basis, typically 1-3 meetings, during times of significant need or crisis.

Care Team leaders are trained volunteers under the direction and general supervision of staff members at Church of the City New York. Regardless of their education, training, licensure or expertise, Care Team leaders do not function in a professional role and do not provide clinically oriented mental health treatment or therapy.

We are here to support you during challenging seasons of life. Please complete the form below and a member of the Care team will reach out to you within 36 hours to coordinate care. If this is an emergency please call 911.

Your name *

Last name

Email address *

Phone number

Phone type

If English is NOT your first language, please let us know your preferred language.

Are you seeking care on behalf of yourself or for someone else? *

Self

Someone else

Please briefly describe the circumstances that have led you to seek support. *

What kind of care are you looking for? (check any that apply)

Care Team Appointment

Counselor Recommendation

Financial Counseling

Financial Crisis Support

Are you currently attending Church of the City?

Yes

Are you connected to any ministries (e.g. Community Group, Youth for the City, Courses, etc.)?

Yes

What is your preferred mode of communication?

Phone Call

Zoom

In-Person

Other

Level of urgency

If this is an emergency call 911.
For mental health emergencies, contact PRS CrisisLink (703-527-4077) or go to your nearest emergency room.

Not urgent

Semi urgent

Urgent

Emergency

Confidentiality Statement

By clicking "Submit" you agree to the following Confidentiality policy.

The Care team member you speak with will make every effort to keep your information confidential. However, information may be released in accordance with NY laws only when:

- a person presents a serious risk of harm to themselves or another person.
- there is evidence or reasonable suspicion of abuse against a child, elder or dependent adult, or spouse.
- there is evidence of a gross distortion of reality or the ability to function in normal daily routines.
- if action is required to protect another congregant, the church itself, or any other interest of the church.

If any of the above conditions are present the Care Team may seek additional support from pastors, elders, or other necessary persons. In all such cases, information is still held in strict confidence.

Church of the City New York
hello@church.nyc
hello@church.nyc