CCF Online Counseling
Dealing with the pandemic is not an easy matter physically, mentally, and emotionally.

You don't have to go through this alone. We are here to listen.

In order for us to connect you with our online counselors, kindly fill up all the necessary information.
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1. Are you a CCFer? (CCF Member or Attendee) *
2. Are you a member of a CCF Discipleship Group (Dgroup)? *
3. First and Last Name (Note #1: If you are requesting for a counseling as a COUPLE, please make sure that your spouse is "aware" of this request and is also "willing" to be counseled. kindly also indicate both of your names. Example: Juan and Juanita Dela Cruz. Note #2: Please provide your name, do not put N/A) *
4. Primary Contact Number ([Mobile Number is required]. If you are from outside the Philippines, kindly provide your VIBER# instead). Kindly double check your #, make sure it's not missing any digit. *
5. Emergency Contact Person and Contact number *
6. Age *
7. Gender *
8. Civil/Marital Status *
9. Dgroup Leader's name and Area Pastor's name (Put N/A if not a Dgroup Member) *
10. Current Location (Please include ONLY your City/Town and/or Province (Ex. Pasig City). *
11. Nature of Counseling Inquiry *
Required
12. What communication platform would you prefer? (check all possible answers) *
Required
13. Which communication options would you prefer? (check all possible answers) *
Required
14. Your Facebook or FB Messenger Link (In case we are unable to reach you thru text, call or thru Viber, we will contact you thru FB Messenger) For instructions on how to get your FB/FB Messenger Link, kindly click this link and watch the video in full screen: https://drive.google.com/file/d/1M5ENbsHnRq0M63t7mH5ffSGl4EDLoK2a/view?usp=sharing *
15. Preferred DATE of Online Counseling (Manila Time) Note: Kindly schedule your request at least 2 to 3 days in advance. If we are unable to provide on your first schedule, we will consider your alternate schedule. ADDTL NOTE: Due to the holiday season, we advise that you choose a schedule that doesn't fall on these dates (Dec 24, 25, 30, 31 and January 1). *
MM
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16. Primary Preferred TIME of Online Counseling (Manila Time) (Note: Choose a time between 9am to 10pm only) *
Time
:
17. Alternative DATE of Online Counseling. (Note: Kindly schedule your request at least 2 to 3 days in advance) ADDTL NOTE: Due to the holiday season, we advise that you choose a schedule that doesn't fall on these dates (Dec 24, 25, 30, 31 and January 1). *
MM
/
DD
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YYYY
18. Alternative TIME of Online Counseling (Must be hours ahead of your PRIMARY preferred schedule. Choose a time between 9 am to 10 pm only) *
Time
:
The information collected and stored will be used solely for the purposes of CCF's Online Counseling Ministry. Any and all disposal of data will be carried out securely and within the timeframe provided by CCF. Information stored or shared to third parties is subject to the privacy policy of CCF. The participant waives any and all possible liability upon the disclosure of personal data to CCF. I hereby check the box below as a proof that I have read and understood the above Data Privacy Statement of CCF and that I agree to the terms and conditions stated therein. *
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