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I'm New
About Us
Meetings
Get Involved
Get Involved
Serving / Crews
Courses
Pastoral Care
Children & Youth
Small Groups
What's On
Prayer
Counseling
Personal Information Form
Identification Information:
Name
*
First Name
Last Name
Contact Number
*
Email
*
Address
*
Birth Date
*
MM
DD
YYYY
Gender
*
Male
Female
Occupation
*
Reason for Seeking Biblical Counseling:
Marital Status
*
Single
Married
Separated
Divorced
Widowed
Engaged
Why do you desire to meet with a biblical counsellor?
*
How long has this issue existed?
*
Were there any significant events occurring in your life/family’s life when this issue began?
*
Have you done anything about this issue previously?
*
How would things be different for you if the issue were remedied?
*
What results are you expecting in coming here for biblical counseling?
*
Marriage & Family Information (Where Relevant)
Spouse's Name
First Name
Last Name
Spouse's Contact Number
Spouse's Email
Spouse's Birth Date
MM
DD
YYYY
Spouse's Address
Spouse's Occupation
Age When Married
Is your spouse willing to come for counseling?
*
Yes
No
Uncertain
Give brief information about any previous marriages:
*
Information about children
Follow this format for each child: Name (PM*), Age, Gender, Education (Grade), Marital Status. *Please indicate if the child is from a previous marriage by adding a (PM) after their names.
Religious Background
How often do you attend church?
*
Does your spouse attend with you?
*
Yes
No
Sometimes
Are you saved?
*
Yes
No
Not sure what you mean
Is your spouse saved?
*
Yes
No
Not sure what you mean
What ministries / activities are you involved in at church?
*
How often do you read your Bible / pray?
*
Describe your relationship with Christ
*
Thank you!
