King of Kings Counseling Inquiry

King of Kings Counseling Inquiry

“Be joyful always; pray continually; give thanks in all circumstances, for this is God’s will for you in Christ Jesus.”1 Thessalonians 5:16-18
King of Kings Church is accepting inquiries to be matched with one of our licensed counselors. King of Kings offers counseling for a wide variety of situations including:
- individual counseling
- marriage and relationship counseling
- anxiety and stress counseling
- family and parent challenges
Fill out the counseling inquiry completely. Take a clear photo or scan in the following documents to be submited
1. Current Photo ID
2. Front of your insurance card (if applicable)
We will review your inquiry to be matched with a counselor and return an answer within 5-7 business days.

If matched with a counselor, you will recieve information about how to schedule an appointment.
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Are you employed*

YesNo
Copy of current driver’s license*

Browse Files

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Phone Number*
Format: (000) 000-0000.
Email*
example@example.com
How did you hear about King of Kings?

I am a King of Kings MemberI am a King of Kings VolunteerOther

Your Need
Please select the kind of counseling you are looking for.*

Individual counselingCouples counselingFamily CounselingCounseling for a minor
Please describe the reason you are inquiring for counseling.*

Insurance Information

In order to match you with a counselor, please provide documentation of your medical insurance:
Do you have medical insurance?*

YesNo
Does your insurance policy cover any percentage of counseling services?*

YesNo
Proof of insurance*

Browse Files

Cancelof
Matching with a counselor will be depenent upon counselor availability.
Term & Conditions*

By submitting this I acknowledge and understand that that all information is correct and I authorize King of Kings to release my information to contracted counselors for placement, and I authorize counselors to update King of Kings. I understand that King of Kings has a committee that reviews these inquiries.
Should be Empty:

Your Need