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Biblical Counseling
This is a personal data inventory so that the elder who is working with you can be sure that they do not over look any important topics that need to be addressed and that the can be prepared to meet with you at your first meeting.
Email address *
Name
Your answer
Sex
Age
Your answer
Marital Status
Email
Your answer
Occupation
Your answer
Education (Last year completed)
Your answer
Other Training (List types & years)
Your answer
Rate Your Health
Declining
Very Good
Have you had any significant weight changes recently?
Your answer
List all important present or past illness, injuries or handicaps
Your answer
Report from that exam
Your answer
Are you presently taking medication?
If yes, please list
Your answer
Have you ever had a severe emotional upset?
If yes, explain
Your answer
Name of Church you Attend (if any)
Your answer
Are you a member?
Church attendance per month
Your answer
Do you consider yourself a religious person?
Do you believe in God?
How often do you pray to God?
Your answer
Are you saved?
How often do you read the bible?
Your answer
Do you have regular family devotions?
Explain recent changes in your religious life, if any
Your answer
Have you ever had any coaching, psychotherapy, or counseling before?
If yes, explain
Your answer
Describe your personality
Your answer
Have you ever felt people were watching you?
Do people's faces ever seem distorted?
Do colors ever seem too bright or too dull?
Are you sometimes unable to judge distance?
Have you ever had hallucinations?
Are you afraid of being in closed in spaces?
Do you have problems sleeping?
Spouse's name
Your answer
Spouse's occupation
Your answer
Is your spouse willing to come for counseling?
Have you ever been separated?
If yes, when?
Your answer
Has either of you ever filed for divorce?
If yes, when?
Your answer
Date of marriage
MM
/
DD
/
YYYY
Your ages when married?
Your answer
How long did you know your spouse before marriage?
Your answer
How long were you engaged?
Your answer
What would you say are the main reasons you got married?
Your answer
Give brief information about any previous marriages
Your answer
Please list all children and indicate if any were from previous relationships
Your answer
If you were reared by anyone other than your parents, briefly explain
Your answer
How many older siblings do you have?
Your answer
How many younger siblings do you have?
Your answer
What is/are the main problems as you see it?
Your answer
What have you done about it?
Your answer
What do you fear? What do you tend to worry about?
Your answer
What can a counselor do? What are your expectations in having a counselor?
Your answer
Describe your motivation for wanting change.
Your answer
What are your three strongest talents?
Your answer
What are your three weakest areas?
Your answer
In writing your epitaph, what would you want people to say about you?
Your answer
What are you doing in your life now that will last forever?
Your answer
Please write any other pertinent information you'd like your counselor to know?
Your answer
Are you willing to be teachable, honest, and will you do your homework?
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