NOTE: This form must be completed in full and signed before a counselor is assigned. Please use "N/A" for any fields that do not apply to you.
If you are struggling with suicidal thoughts, please call 911 for immediate assitance.
IMPORTANT SCHEDULING DISCLOSURE: Your counseling sessions will be held on our church campus. Our counselors do not counsel via zoom and we do not provide childcare. You can anticipate about 1 -1.5 hours per session per week. While we understand that a job may limit your availability, please understand that our counselors can also be limited as to when they can meet. Most of our counselors are lay counselors and some have full-time jobs with families outside of counseling. Therefore, flexibility on your behalf is important. For example, you may be asked to speak to your employer about some time off during a day to meet if your counselor cannot meet during the evening, or vice versa. In essence, the more flexible you are with your schedule, your wait time for a counselor will be less. Most counselors do not meet over the weekend, but ultimately that is up to the counselor. We cannot reassign you to another counselor simply based on scheduling conflicts. Thanks for your understanding as we partner with you to steward our counselor's time in the best way.