Please complete the following form for the Life Together spiritual accompaniment/direction program. Your answers will be kept confidential and will be used to help find the right spiritual director for you. Should you have any questions or concerns, please contact Perry Dougherty at perry@stillharbor.org.

Name (First and Last) *
Name (First and Last)
Date of Birth
Date of Birth
Address
Address
Phone *
Phone
Please indicate three days of the week that you might like to meet. *
Choose three or more days that may be options for you.
Please indicate whether there are certain times of day that might work better for you than others.
We will do our best to match you with a spiritual director that can work with your day and time preferences.