Counseling Intake Form

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Thank you so much for choosing Career Compass LLC as your form of Christian counseling. Please take a few moments to fill out this brief intake form so we can gather more information. This will help us to better prepare for our first meeting - the first step towards your improved mental health. Our meetings will occur through Google Meets. Once your information has been received, I will work to get you scheduled as soon as possible. Sessions are $50 per hour. If you need to cancel or reschedule, please do so within 24 hours of the scheduled appointment. Otherwise, you will be charged a $25 cancellation fee.

First Name: *

Last Name: *

Email Address: *

Age: *

Have you attended counseling before? *

Yes

If you had to select, which of the following topics would best pertain to your reason for seeking counseling (Select all that apply): *

Marriage

Anger

Depression

Anxiety

General life guidance

Other

Required

What do you hope to get out of counseling? (Feel free to be as brief or as detailed as you would like) *

How did you hear about us?

Referred

The HJ Brand

Social Media

Other:

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