GraceLife Biblical Counseling Intake Form
gracelifedecatur.org/biblical-counseling
Email address
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example@example.com
First Name
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Last Name
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Phone
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Date of Birth
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-
Month
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Day
Year
Date Picker Icon
Home Address
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Gender
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Male
Female
Marital Status
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Married
Engaged
Unmarried
Divorced
Widowed
Separated
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Are you a member of a church?
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Yes
No
Where are you a member of a church?
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GraceLife
Other
Where are you a member of a church?
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GraceLife
Other
Besides membership, do you hold any responsibilities in your church?
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For what issue are you seeking biblical counseling?
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How long have you been struggling with this issue?
Have you received prior help/biblical counseling on this issue in the past?
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Yes
No
Do you feel prior help/biblical counseling has been effective? Why or why not.?
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What are your expectations/concerns with biblical counseling, if any?
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Is there any other important information you would like us to know?
Consent Form (sign below)
GraceLife Counseling exists to provide biblical counseling that is centered on Scripture and designed to help individuals face life's challenges in a way that honors Jesus Christ and promotes spiritual growth. Counseling is based on the belief that the Bible provides sufficient guidance for faith and life, and counselors offer care from a biblical perspective rather than as licensed mental health professionals. While they may encourage counselees to seek legal, medical, financial, or other professional advice when appropriate, all counsel is intended to complement those services through the application of biblical principles. Counselors are ACBC or IBCD certified, or are working toward certification under supervision, and may consult with pastors or fellow counselors when additional wisdom is needed. The counseling ministry values confidentiality and will make every effort to protect personal information. However, counselees should understand that confidentiality has biblical and legal limits. Information may be shared when necessary to protect someone from harm, report suspected abuse or criminal activity, comply with legal requirements, seek supervisory guidance, involve church leadership for pastoral care, or, in cases of persistent unrepentant sin, follow the biblical process of church discipline. Because GraceLife is also a training ministry, counseling sessions may include supervised observers, and audio or video recordings will only be made with permission. Counselors do not provide medical advice, including recommendations regarding psychiatric medications, and encourage counselees to consult qualified medical professionals before making any changes to prescribed treatment. Biblical counseling is offered free of charge to GraceLife Church members and regular attenders, while individuals attending another church are asked to contribute a suggested fee to help offset administrative costs, with financial assistance available so no one is turned away due to inability to pay. Minors must have parental involvement throughout the counseling process, and all counselees are expected to remain actively involved in their local church. Those who are not members of GraceLife are also asked to designate a church leader or mature believer from their home church to serve as an advocate during counseling. Finally, any disputes arising from the counseling relationship are to be resolved through Christian mediation and, if necessary, binding arbitration rather than civil litigation. By signing the agreement, counselees acknowledge their understanding and acceptance of these policies and the biblical foundation of the counseling ministry.
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