Member Care Intake Form

We are glad you are reaching out for member care and we will do our best to get you connected to the help you need.  Your responses to the questions below will go directly to our Intake and Referral Team.  This team meets weekly and someone from the team will get back to you within a few days.  If you do not hear back from anyone within a week, then please write to  to let us know.

Barnabas International is a pastoral care organization offering a variety of services for global workers.  Due to our limited number of staff and resources, we prioritize global workers who are currently living and working outside of their own passport country. 

Additionally, where licensed counseling is requested, licensing laws restrict clinical counselors from providing US-based care to anyone who is not physically located in the provider’s state of licensure. Therefore, if a global worker is currently based in the United States, we will most often offer referral options outside of Barnabas International.

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Full Name

Care Recipient Information

Age (of person needing care)
Gender
Current Marital Status (choose all that apply)
Current Geographical Location

What type of help are you seeking?

Select a maximum of two options that apply from the following options. [Click here for an explanation of provided services (opens new window)].

Help Being Sought:
Did someone refer you to Barnabas?

NOTE: Barnabas does not charge a fee for service. For more information click here (new window).