Counseling Request Form
Name
First Name
Last Name
E-mail
example@example.com
Phone Number
-
Area Code
Phone Number
Age of person(s) requesting counseling
Children and their ages
If married, how many years married?
Preference for counseling
Pastoral Counseling: Counseling by an OFA pastoral staff.
Professional Counseling: OFA referral of Christian-based counseling by a degreed counselor.
Description of counseling needs.
Have you previously received counseling services?
Do you currently attend Owasso First Assembly?
Do you have insurance that would help cover the cost of professional counseling?
(Please note that not having insurance will not prevent you from obtaining professional counseling services.)
If you do not attend Owasso First Assembly, do you have a church home?
Please note that Owasso First Assembly will not be able to financially assist non-OFA attendees seeking professional counseling. OFA may be able to assist you with pastoral counseling or help you get in touch with a professional counselor.
Submit Form
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