Intake form

Help us serve you better

Name *

Email address *

What is your current military status?

What services are you interested in?

Please select at least one option.

Divine Detox Centers

PTSD Restoration Cohorts

Legal Advocacy

Theological Advocacy

Volunteer Opportunities

Donation Information

What challenges are you currently facing?

How did you hear about us?

Are you interested in participating in a support group?

What is your preferred method of communication?

Please specify any specific needs or requests you may have.

Additional questions or comments

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The Sacred Restoration Ministry Corp.