Biblical Coaching Request Form
No matter what struggles, challenges, hardships, or pain you are experiencing, we want you to know that you are not alone. Our Restore Coaching program is here to provide an avenue to help you process and navigate through some of life's most challenging times. We have trained & caring people who are ready and willing walk alongside you without judgement or quick fixes but with patience, compassion, and love. 

If you are in need of biblical guidance and support as you are navigating current life circumstances & struggles, please complete this form and we will be in touch with you soon. We offer up to 10 biblical coaching sessions free of charge and are already praying for what God has for you through this Restore coaching process. 

If you would like to know our Clovis Hills Statement of Beliefs  - click HERE
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Email *
Name (First/Last) *
Phone (cell) *
Do you prefer email, text, or phone call for appointment setting and reminders? *
Required
Best time to contact?
Home/Mailing Address (street/city/zip) *
Gender *
Required
Marital/Relationship Status *
Required
Age Bracket
Education Level *
Required
My Appointment Availability *
Required
What is the reason you are seeking Biblical Coaching? (please provide enough detail so we can gather the best resources for you). *
Have you sought help or counseling in the past? *
Are you currently seeing a Therapist or meeting with a Licensed Counselor? *
Required
If you have worked with a counselor/therapist - have you been given a diagnosis or treatment for diagnosis? *
Are you currently using prescribed medication? If so, how long have you been on medication? What is the medication for? *
Do you drink alcoholic beverages? *
Required
Are you or have you been a part of a Addiction/Recovery Program? *
Required
Have you ever been arrested? If so, what were the charges? *
Have you recieved Jesus Christ personally as your Savior? *
Required
Have you been Baptized? *
Required
Do you attend church services regularly? If so, where and when do you attend? *
Do you have a mentor? *
Required
Are you in a community group/growth group? *
Required
How can we be praying for you while this coaching assignment is pending? 

(If you find yourself in a crisis or emergency and you need help right away - please call 911 or 988 for assistance).
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