Counseling Request Form

If you’d like to request biblical counseling from Calvary Baptist Church, the first step is to fill out this form. Once you have completed and submitted your form, someone will email you as soon as possible to arrange a meeting.

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Thank you for your response. ✨

Sex

I’m interested in counseling for (check all that apply):

HEALTH

Rate your health

Are you currently taking medication?

Have you ever used drugs for other than medical purposes?

Have you ever been physically abused, either as a child or as an adult?

Have you ever been sexually molested/abused, either as a child or as an adult?

Have you had any previous counseling or therapy with a psychiatrist, psychologist, therapist, counselor, etc.?

Have you ever abused alcohol or drugs (including prescription or non-prescription)?

Have you ever been arrested?

Have you recently suffered the loss of someone who was close to you?

EDUCATION

MARRIAGE & FAMILY

Marital Status

Is your spouse willing to come for counseling?

Have you ever been separated?

Have either of you ever filed for divorce?

RELIGIOUS

Are you currently attending a church or other religious gathering?

Are you a member?

How often do you typically attend per month?

Do you consider yourself a religious person?

Do you believe you are a Christian?

Do you believe in God?

Do you ever pray?

COUNSELING