Neighbor to Neighbor Check-In Form

Neighbor to Neighbor Ministry
Please fill out this form whenever you meet with your neighbor

Your Information

Name

*

Email

*

This address will receive a confirmation email

Phone

*

Your Neighbor's Information

Please fill out this information about the person with whom you met.

Name of your Neighbor

*

When did you meet with them?

*

Where did you meet:

*

Overall Impression of their mental/emotional wellbeing?

*

Please select one option.

They're doing well They're getting by They are struggling significantly

Were you there for the Talk Team or the Task Team?

*

Please select all that apply.

Talk Team Task Team

Did you serve communion?

*

Please select all that apply.

Yes No

Talk Team

Please only fill out this section if you are on the Talk Team

Summarize your conversation (Vague description is fine. Please honor confidentiality, and no need for a lot of details.)

Does this neighbor need a follow-up call from a pastor?

Please select all that apply.

Yes Maybe Not at this time

Anything else you'd like the pastors to know?

Task Team

Please only fill out this section if you are on the Task Team

What task did you do today?

Did you feel safe in completing your tasks?

Please select all that apply.

Yes No

Any future plans to go back to this neighbor at this time?

Description

Neighbor to Neighbor Ministry
Please fill out this form whenever you meet with your neighbor

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