1.What is your name? (You are not required to answer this and can submit your feedback without a name.)

2.Is there a counselor or staff member you would like to recognize for their work? No detail is too small to share!

3.How has your life been touched by Samaritan Counseling Center, either in small ways or big ways?

4.By submitting your story, you consent to Samaritan Counseling Center sharing your story for promotional materials. We respect your privacy, so please indicate your preference.

Do not use my name or identifying information.

Feel free to use my name.