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Journeys Counseling Ministry

Email *

First Name *

Last Name *

Phone Number *

Location Preferences *

Costa Mesa

Mission Viejo

Oceanside/Carlsbad

Santa Ana

South Bay

North Dallas

Type of Service *

Couples Therapy

Child Therapy

Individual Therapy

Family Therapy

Teen Therapy

Coaching

Pastoral Support

Pastoral Training

Psych Testing

Speaking/Teaching Services

Spiritual Direction

Required

Do you have a preference for in-person or telehealth? *

In-person preferred

Telehealth preferred

Either in-person or telehealth

Do you have a therapist you would prefer to meet with? *

Male or Female

Male Only

Female Only

By Name (Please enter name in comments box)

How did you hear about us? *

Friend/Relative

Internet Search

Social Media

Google Ad

Postcard

Church (Please tell us which church in the comments box)

Conference/Event (Please tell us which event in the comments box)

Questions/Comments

Send me a copy of my responses.

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