Group Registration Form

Thank you for your interest in the Journey to Heal Women's Group at Port City Church in Wilmington, NC. This 8-week, trauma-informed Care Group, is Gospel-Centered and Biblically-based. It is built on authenticity and confidentiality, taking women through seven important steps in healing covered in Journey to Heal: Seven Essential Steps of Recovery for Survivors of Sexual Abuse by author and survivor, Crystal Sutherland, MTS." It is intended for adult women who have experienced any form of sexual abuse in their childhood or adulthood.
1) Groups are kept at 3-5 members, and meet for 8 consecutive weeks at Port City Church in Wilmington.
2) The Fall 2025 JTH Group starts Tuesday, 8/26/25 and runs through October 21st (w/ a break on 9/30).
3) Materials you'll need include:
  • A copy of Journey to Heal
  • A copy of the Bible in a translation you understand
  • A personal journal for writing and homework
4) To register, please complete our brief form below. This form will help us to ensure we provide you the best possible care during our 8-week group. A member of our team will follow up via email or by phone within a week to confirm your registration and set up a time to connect with you prior to the group start date.

We look forward to serving you!

- The Journey to Heal Ministry Team

Confidentiality Note: All information contained in this form is confidential and is used for the sole purpose of the group. We understand these questions are sensitive and appreciate your willingness to help us better understand your story and create a safe place for you to heal.

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* 1. Full Name:

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* 2. Age or Birthdate:

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* 3. Email:

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* 4. Best Contact Phone #:

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* 5. City & State:

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* 6. How did you hear about the Journey to Heal Study?

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* 7. What made you decide to sign up for the study at this time?

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* 8. Your abuse/assault was committed by:

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* 9. How old were you during the abuse?

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* 10. What steps have you taken in your healing so far? (i.e. professional counseling, support groups, medical care, EMDR, reported to authorities/filed charges, talked to a friend or mentor).

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* 11. Do you suffer from any specific mental or physical health concerns? (i.e. Bipolar Disorder, Borderline Personality, pelvic or back issues, chronic migraines, chronic lower back pain)

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* 12. Do you struggle with any of the following at this time?: anxiety, depression, physical pain, intimacy/relationship issues, self-harming, eating disorders, anger, flashbacks, suicidal ideation, or other PTSD symptoms? And/or have you been diagnosed with PTSD (Post Traumatic Stress Disorder)?

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* 13. Are you on any kind of medications for anxiety, depression, or any health condition related to your mental health?

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* 14. Are you currently in any addiction recovery? (substances, alcohol, or sexual addictions)

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* 15. Are you currently in any form of contact with the person(s) who abused you?

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* 16. Do you understand that this is a Gospel-centered, Biblically based women's study for survivors of sexual abuse?

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* 17. Are you currently being abused in any way? If so, please explain:

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* 18. Briefly describe your faith and relationship with Jesus Christ:

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* 19. Are you actively attending a local church or women's Bible study?

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* 20. What is the name and number of who you'd like us to contact in case of an emergency?

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* 21. Please share any additional comments or questions you might have, here:

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