Care For The One - I Have A Need (2026)*

**Medical emergency: Please call 911.
***Suicidal or self-harm thoughts: Please call or text 988

At The Well, we desire to care for one another. Please use this form to request care from our team. We also have numerous community resources available at https://www.thewellslc.com/resources/

The Well operates Sunday through Thursday. All submissions will be responded to by the next business day.

Your name *

Email address *

Address *

Phone number *

Gender

Marital status

What kind of help do you need? *

Please Check All That Apply

Counseling

Financial Support

Food/Groceries

Other

In 2–3 sentences, briefly describe your situation.

**All information is kept confidential**

How are you involved at The Well? *

Please check all that apply

I am currently serving on a team at The Well

I am in a Formation Group at The Well

I am regularly attending The Well

I am not part of The Well

Thanks for reaching out!

All communication regarding your request will be done through the email provided on this form.

A copy of your responses will be sent to your email address.