Biblical Counseling Intake and Consent Form

Biblical Counseling Intake and Consent Form

Please complete this form in its entirety, and our Biblical Counselor, Brian Munnings, will contact you soon.
Name:

First NameLast Name
Birthdate:
Age:
Gender:
Marital Status:
Referred by:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email:
example@example.com
Cell Phone:
Please enter a valid phone number.
Home Phone:
Please enter a valid phone number.
Work Phone:
Please enter a valid phone number.
How long have you been attending The Church at Brook Hills?
Are you a member of Brook Hills? Another church?
Are you serving in any capacity at Brook Hills? If so, in what areas are you serving?
Are you in a small group? If so, who is your leader?
Personal Questionnaire
For what issue are you seeking counseling?
How long have you been struggling with this issue?
Have you received prior help/counseling on this issue in the past?
Is there anything you have found helpful with this issue thus far?
What are your expectations from counseling?
Is there any other important information we should know?
Counseling Consent
The Biblical Counseling ministry at The Church at Brook Hills is under the authority of the pastors/elders. We offer biblical counseling services which seeks to use scripture as a lens by which we understand who God is, who we are, how to effectively interpret and diagnose life’s problems, and provide hope and healing through the power of the Spirit working in our lives. We will also interact with and learn from other disciplines in our desire to care for you holistically. We will consider the whole person, the inner (heart) and outer (body) man while also taking seriously your particular circumstances. Our desire is for you to grow in faith, trust and hope in Jesus as you navigate your particular suffering and difficulties.

The counseling sessions will feel personal and relational. We want you to feel safe and able to share the things on your heart. There may be times when your personal information could be shared with other members of our staff /pastors/elders or other authorities if we discern it will be helpful in caring for you or if we are required legally to do so.

For training purposes we may ask for a counselor in-training to be a part of the counseling sessions. We will discuss this with you prior to your first session. We also encourage you to bring a friend or other support with you if that would be helpful.

Please sign and date this form to show you understand and agree with the above information. Please feel free to ask any clarifying questions you may have in regards to the above information either in or before your first counseling session.
Date:

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Biblical Counseling Intake and Consent Form

Personal Questionnaire

Counseling Consent