ServingLeaders | SL Counseling -- Confidential Counseling Inquiry Form
If you have any questions, contact Angela Commiskey at acommiskey@servingleaders.org or 484-301-0753.
Contact Information
Name: *
Your answer
Spouse Name (for couples counseling):
Your answer
Age: *
Your answer
Phone Number: *
Your answer
Can we leave a voicemail? *
Email Address: *
Your answer
Contact Preference
Town of Residence *
Your answer
How did you hear about ServingLeaders | SL Counseling? *
If "Other" fill in how/where below:
Your answer
Counseling Preferences
Please Select: *
Preference for Counseling Location: *
In several sentences please summarize what is prompting you to come to counseling and what you would like to focus on: *
Your answer
Availability during the week (please provide specific time ranges for specific days): *
Your answer
Preference for male or female counselor (we do our best to accommodate but cannot guarantee that your preference will be met).
Current Ministry Involvement
Do you play a leadership role in a ministry? *
If involved in ministry, in what capacity?
Your answer
Fee Structure & Questions/Comments
Sessions vary in cost from $120-150 depending on the experience and credentialing of the counselor.
Do you have any other questions or concerns about counseling?
Your answer
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