Counselling Booking Form
Use this form to book your counselling session with our certified Senior Pastor.
Your Details
Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Gender
*
Please Select
Male
Female
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Are you a JPPM Member?
*
Yes
No
No, but I would like to become one
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Session Details
Select the session you'd like to book.
Counselling Type
General Counselling
Youth Counselling
Spiritual Counselling
Relationship Counselling
Pre-Marital Counselling
Marriage Counselling
My Products
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Categories:
All
All
Longer Sessions
One-On-One Sessions
Couple Sessions
Group Counselling
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Name: A to Z
Name: Z to A
Price: Low to High
Price: High to Low
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One on One Counselling
One on one session to talk about anything you may be going through or may need advice on.
$
180.00
AUD
Quantity
1
2
3
4
5
6
7
8
9
10
Couples' Counselling
Includes relationship counselling, pre-marital counselling and marriage counselling.
$
230.00
AUD
Family Counselling
Note: This session is for an hour.
$
230.00
AUD
In addition to yourself, select the number of people who will be attending the session.
1
2
3
4
5
Longer One-on-one session
$
180.00
AUD
Number of Hours
2
3
Longer Couple sessions
$
230.00
AUD
Number of Hours
2
3
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
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Appointment Details
Select your preferred appointment date and time.
Select your preferred Method of meeting:
*
In-Person
Virtual (Video Call)
Phone Call
Appointment
CANCELLATION POLICY
PLEASE READ BEFORE YOU SUBMIT
Please be advised that cancellations made up to 48 hours before a scheduled appointment via [email, text, phone call] will be processed without a penalty. Cancellations made 48 hours or less before an appointment will be subject to a charge of half the service rate. By submitting this form you confirm that you have read and understood our cancellation policy.
*
I have read and understood the cancellation policy
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