Pastoral Counseling Request
Please fill out this short form to help our administrative office serve you better in your spiritual counseling needs. We also ask that you take a moment and read the counseling disclaimer below:

COUNSELING DISCLAIMER:
Completing this request form affirms your acknowledgement and adherence to the following conditions for counseling with Pastor and/or Lady Rouson.

1. Any sessions conducted by Pastor and/or Lady Rouson are considered "spiritual counseling" and are not to be categorized as clinical psychotherapy services.

2. As such, there is no fee for spiritual counseling. Furthermore, pastoral counseling is considered a part of pastoral care for partners of the ministry. However, donations may be made if the counselor decides at will.

3. You do have the opportunity to request counseling with either Pastor or Lady Rouson individually; however, they each reserve the ethical right to include one another in the session or to apprise one another of the nature of the session(s) for pastoral accountability.

4. Due to Lady Rouson's secular career, requests to have both Pastor and Lady Rouson facilitate TOGETHER may require additional time or may need to occur at certain times (evenings, weekends, etc.). We ask for your patience.

5. All pastoral counseling is considered confidential and its contents will not be divulged.

6. Pastor and Lady Rouson do reserve the right to make any session virtual if needed, so long as proper notification is given to the requestee.

7. Completion of this REQUEST does not automatically equate to a booked counseling session. Our team will confirm next steps if counseling will occur within 24-48 hours. 
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Email *
Your Name *
Your phone number *
Are you a partner of The Place of Change?           (you do NOT have to be) *
Would you PREFER... *
Please specify the nature (reason) of your request for pastoral counseling *
Is your need specifically for PRE-MARITAL counseling and a desire for Pastor to perform your wedding? If so, you also need to fill out our marriage/wedding form at this link below:  *
Which is your preferred time slot to meet? (*The final date will be confirmed by our assistant)  *
Required
If tentative date and time has already been selected, please state it below for verification. If one has not been selected, you will have an opportunity to do so.
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A copy of your responses will be emailed to the address you provided.
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