Counseling Request Form
So that we can best serve you, please fill out the following form, and one of our pastors will contact you shortly.
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Email *
Last Name, First Name
Cell Phone Number
Marriage Status
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Please describe the nature of the problem the person who is seeking counseling is facing.
How long has this been an issue?
Where else have you turned for help?
Are you committed to following God's will, as He as revealed it to us in the Bible?
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Are you committed to doing the necessary homework between the counseling sessions in order to address the problem?
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I understand that the counseling will be based upon Christian principles as found in the Bible which is the final authority in all cases. If the counselee is unwilling to use the Bible as the final authority or unwilling to do the assigned homework, I understand sessions will be terminated.
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If you are seeing another pastor/counselor and are okay with us sharing information with one another in order to better serve you, please initial below and leave their contact information.
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