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Counseling at New Life Sign-Up Form
Greetings! This is the New Life Church site from which you can sign up to receive professional counseling here.

Here at New Life, we have the following professional counselors:

Mark Bishop, MA, LLPC.
Rachel Stewart, MSW, LLMSW

After you fill out this form, one of us will get back to you within a week to schedule a first appointment, which is free. At your first meeting, you can discuss any questions you have about your counselor or the counseling process.

Our rates are the following:
$80/50-min. session and $70/50-min. session for current students.

(All these fees are discounted from a normal counseling fee as a service to New Life Church.)

Further need-based fee reductions may be available through an application process, depending on the counselor. To qualify for a fee reduction, clients must fill out our Fee Reduction Application (which includes a detailed budget) to demonstrate that they have financial need and have made every effort to pay as close to a full fee as is possible.

At times, we may have a waiting list for ongoing counseling. If you would prefer not to wait, here is a list of other counselors that we recommend:
https://docs.google.com/document/d/1SnLLSekPN448esrgU2fano-HKs19fN0Z3nYGSjE7Mn8/edit?usp=sharing
First and Last Name *
Your answer
Email Address *
Your answer
How would you like us to get in touch with you? *
(Be informed that we cannot guarantee the security or privacy of the various forms of electronic communication. Your answer to this question constitutes permission for us to contact you using the method(s) you check, and your willingness to assume any associated privacy risks.)
Required
What type of counseling would you prefer? *
For counseling, I would prefer to meet with
What is your gender? *
How old are you? *
Your answer
What is your phase of life? *
Who referred you for counseling, and how do you know them? *
Your answer
Select the option that best describes your involvement in New Life Church *
What issue(s) are you seeking help with? *
(Please answer within a few sentences or a short paragraph.)
Your answer
What led you to pursue counseling for help with this issue? (How did the idea occur to you, and what led you to the point of deciding to initiate this process?) *
(Please answer within a few sentences or a short paragraph.)
Your answer
What other forms of help have you pursued? (such as help from friends, family, small groups, mentors, support groups, pastors, University services, previous therapy/counseling, etc.). *
(Please answer within a few sentences or a short paragraph.)
Your answer
What days/times are you available in the next few weeks for an initial appointment? *
(Listing your availability does not guarantee an appointment will be available at that time, but we will do our best to accommodate your schedule.)
Your answer
Please indicate your counseling and waiting list preferences. *
Check as many as apply.
Required
I am hoping to receive ongoing counseling, and I want to apply for a need-based fee reduction. Please send me the Fee Reduction Application. *
I would like help in learning how to make a budget for my Fee Reduction Application.
(When you apply for a fee reduction, you will be asked to provide a detailed budget so your financial need can be assessed. We can refer you to NLC members with financial expertise who have volunteered to help Rivendell clients learn how to make a budget.)
If you have any questions or comments for your counselor, please write them here.
Your answer
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