APPOINTMENT REQUEST
APPOINTMENT REQUEST

* First Name:
* Last Name:
City:
State / Province
* Phone:
* Email:
This form is to schedule an appointment/counseling or conference session with Pastor Dennis E. Thomas. Please complete the form below. Please be as specific as possible. Rest assured that your information will remain confidential. This form will go DIRECTLY to Pastor Thomas for review and scheduling.

TYPE of MEETING
* Reason for requesting to meet with Pastor Thomas
Self
Pre-Marital Counseling
Couple/Marital Counseling
Family/Group Meeting
Auxiliary/Ministry Meeting
Funeral Preparation
OTHER (please indicate below)
If you answered OTHER, please indicate reason for meeting below:
* Indicate day(s) that best fit your schedule (choose ALL that apply)
Mondays
Tuesdays
Thursdays
* Indicate time of day which best fits your schedule to meet.
1:00 p.m. - 2:30 p.m.
2:30 p.m. - 4:30 p.m.
4:30 p.m. - 6:00 p.m.
Any time is suitable
* Can this issue be addressed via telephone/conference call?
YES
NO
Any additional notes/requests?:

* Indicates required entry field