BASIC INFORMATION SHEET
THIS FORM WILL HELP THE COUNSELOR TO KNOW IN ADVANCE WHAT SPECIFIC NEEDS YOU WILL NEED ADDRESSED IN THE COUNSELING ENVIRONMENT. PLEASE ANSWER OPENLY AND HONESTLY. THE INFORMATION PROVIDED IN THIS FORM IS COMPLETELY SECURE AND CONFIDENTIAL.
Name *
Phone Number *
WHAT IS THE MAIN PROBLEM, AS YOU SEE IT? WHAT BRINGS YOU TO THE COUNSELING MINISTRY? *
WHAT HAVE YOU DONE ABOUT IT? *
WHAT CAN WE DO? WHAT ARE YOUR EXPECTATIONS IN SEEKING HELP THROUGH THE COUNSELING MINISTRY? *
AS YOU SEE YOURSELF, WHAT KIND OF PERSON ARE YOU? DESCRIBE YOURSELF. *
IS THERE ANY OTHER INFORMATION WE SHOULD KNOW? *
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