Crisis Healing Center                                      YOUR CRISIS "STORY"

                                                              Please answer the 6 questions below:

                                                    1.  What crisis are you facing?

                                                     2.  What is your greatest need?

                                                     3.  How have friends/others been helpful?

                                                     4.  What has been the least helpful, maybe even your greatest disappointment?

                                                     5.  What are your feelings that have been most prevalent during this time?

                                                     6.  What other information would you like to share?

                                                  Name_________________________________

                                                  E-mail Address:_________________________

Next copy this page and send, along with your answers to: szimmerman@CRISISHEALINGCENTER.com