Abiding in Truth Biblical Counseling Intake Form

Biblical Counseling Intake Form

Please complete this form to help us understand your background and prepare for your biblical counseling sessions.
Personal Information
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Gender*
Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Occupation
Employer
Marital and Family Information
Marital Status*
Spouse Name (if married)
Spouse Occupation
Children (list names and ages)
Church Involvement
Do you regularly attend church?*
Church Name
Pastor's Name
How often do you attend church?
Are you a member of this church?
Are you involved in ministry? If yes, describe.
Spiritual Background
When did you become a Christian?
Briefly describe your salvation testimony
How would you describe your current relationship with the Lord?
How often do you read the Bible?
How often do you pray?
Counseling Concerns
Why are you seeking counseling?*
How long has this issue been present?
What have you already tried to address this issue?
What changes would you like to see in your life?
Personal Background
Briefly describe your upbringing
Were your parents married, divorced, separated, or other?
How would you describe your relationship with your parents growing up?
Health Information
Do you currently have any major medical conditions? If yes, explain.
Are you currently taking medication? If yes, list medication and purpose.
Have you previously received counseling? If yes, when and for what issue?
AnxietyDepressionAngerFearMarriage conflictParenting strugglesSexual sinAddictionGriefTraumaLonelinessOther
Counseling Expectations
What do you hope to gain from biblical counseling?
Are you willing to attend sessions regularly?*
Are you willing to complete homework assignments?*
Are you willing to apply Scripture to your life?*
Are you willing to receive counsel from the Bible even when it challenges your current thinking?*
Additional Information
Is there anything else we should know before meeting with you?
Acknowledgment
I Agree
Signature*

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Biblical Counseling Intake Form

Personal Information

Marital and Family Information

Church Involvement

Spiritual Background

Counseling Concerns

Personal Background

Health Information

Counseling Expectations

Additional Information

Acknowledgment