Brainerd SDA Church

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Pastors Member Survey

Please fill out the form below and click the submit button when you have completed the form. It will then be sent only to the church pastor. Note that some fields are marked * which means you need to complete that field with some information or just enter N/A where appropriate. Responses are not limited to one person per family.

Today's Date

Section One

Personal Information

Name

Address

Phone

Section Two

Home Visit Information

Are you Open to a visit from the pastor

Yes No

Tuesday's Visits (Indicate Times or enter N/A)

Wednesday's Visits (Indicate Times or enter N/A)

Thursday's Visits (Indicate Times or enter N/A)

Section Three

Do you know of anyone that would also appreciate a pastoral visit? Please fill out each contact information below:

Suggested Visit 1, please select yes or no

Yes No

Suggested visit 1 Name

Suggested visit 1 Address

Suggested visit 1 Email

Suggested visit 1 Phone

If possible, would you be willing to visit person 1 with pastor?

Yes No

Suggested Visit 2, please select yes or no

Yes No

Suggested visit 2 Name

Suggested visit 2 Address

Suggested visit 2 Email

Suggested visit 2 Phone

If possible, would you be willing to visit person 2 with pastor?

Yes No

Suggested Visit 3, please select yes or no

Yes No

Suggested visit 3 Name

Suggested visit 3 Address

Suggested visit 3 Email

Suggested visit 3 Phone

2: If possible, would you be willing to visit person 3 with pastor?

Yes No

Additional Suggested Visits, please select yes or no

Yes No

Additional Suggested Visits. Please enter all information below for any additional visits with requested information types from above.

Section 4

Please answer all questions listed below. If you have no comment as to a question, please enter N/A into that field.

1. What kind of support would you like from our pastor?

2. What would you like to see happen in the church?

3. What has been meaningful to you?

4. What has not worked in your opinion?

5. What are some of your ideas to help grow our church community?

6. Do you have any special requests that we can keep in prayer for you?

7. Please share any additional questions or comments you have to share with the pastor.

Do you feel this survey has been helpful?

Maybe Yes No