Christian Counseling Spiritual Assessment
Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
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example@example.com
Date of Birth
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Marital Status
Who referred you to us?
Section 2: Spiritual Background Were you raised in a particular faith tradition or denomination? (Yes/No) If yes, which one?
Do you currently identify with a particular faith or belief system?
Christianity
Spiritual but not religious
Other (please specify)
None
How would you describe your current relationship with God?
Close
Growing
Distant
Struggling
Not sure
Have you ever accepted Jesus Christ as your Lord and Savior?
Yes
No
I’m not sure
Section 3: Prayer & Worship Do you pray?
Daily
Occasionally
Rarely
Never
Do you attend a church or place of worship?
Regularly
Occasionally
Rarely
No
If yes, where?
Section 4: Bible & Faith Exploration Have you read the Bible or parts of it before?
Yes
No
I’ve just started
Are you open to exploring Scripture and biblical truth during counseling?
Yes
No
Maybe-I’d like to know more
What are some questions you have about faith or God?
Section 5: Areas of Spiritual Concern Are you currently struggling with any of the following?
Unforgiveness
Fear or Anxiety
Shame or Guilt
Doubt or Loss of Faith
Trauma or Grief
Feeling distant from God
Identity or Purpose
Other
What do you believe God thinks or feels about you?
Do you have any past spiritual wounds you’d like to share?
Section 6: Hope & Healing What would you like to experience or discover spiritually during counseling?
Clarity in my beliefs
Peace and healing
Freedom from guilt or shame
Deeper relationship with God
Other
What do you believe God thinks or feels about you?
Section 7: Consent & Comfort Are you comfortable with your counselor praying with or for you? (Yes/No/Maybe) Are there any specific topics you do not want to discuss during spiritual conversations?
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