Christian Counseling Request

The RE3 Christian Counseling & Mental Health Ministry at Bayview Church produces trained and compassionate counselors and support group leaders who facilitate a free service (*with the exception of Pre-Marital Counseling, there is a $50 fee/couple to cover the cost of the Pre-Marital Counseling Curriculum) for individuals seeking guidance for a variety of issues including but not limited to marital and family relationships, communication and intimacy, parenting, grief and loss, anger and bitterness, inner personal struggles, mental health difficulties, and spiritual discouragement. RE3 Volunteers receive extensive training, and supervision. The ministry helps to fulfill Pastor Terry’s vision for Bayview- that is to be the church for the community where the hurting, the depressed, the frustrated and the confused can find love, acceptance, help, hope, forgiveness, guidance and encouragement.

Biblical Basis:

Bayview Church believes that the Bible provides thorough guidance and instruction for faith and life. We believe the Bible is God's all-sufficient guide for relational living. There is a route to life, our Lord is that way. Christ is the truth who frees us to love. He is the life who satisfies the deepest thirsts of our soul. Therefore, our short-term guidance is based on Scriptural principles that are supported by practical guidance. Christian Counselors at Bayview Church are not licensed as therapists or mental health professionals but are trained leaders who can provide solid Biblical guidance.

Not Professional Advice:

As a discipleship ministry of Bayview Church, our services are free (*with the exception of Pre-Marital Counseling, there is a $50 fee/couple to cover the cost of your Counseling Curriculum & Shipping). Our Christian Counselors are not authorized to provide professional advice or services. We offer to you the following:

• Individual Biblical counseling regarding spiritual and personal issues.
• Marital and Pre-Marital Biblical counseling.
• Family/Parental Biblical counseling

If you have significant legal, financial, medical, or other technical questions, you should seek assistance from an independent professional. The Christian Counseling Ministry will make available a list of professional resources upon request.

Confidentiality:

Confidentiality is an important aspect of the counseling process, and we will carefully guard the information you entrust to us. Please be assured that our counselors strongly prefer not to disclose personal information to others, and they will make every effort to help you find ways to resolve a problem as privately as possible. However, it is important for you to understand that there are certain circumstances where it may be necessary for us to share information with others:

1) When a Christian Counselor needs to seek guidance from the Christian Counseling Director.
2) Where California law dictates:
• If the Christian Counselor has reasonable cause to believe that a child or elder has been the victim of abuse, he/she must report the suspected abuse to the appropriate protective agency immediately by telephone, to be followed by a written report within 36 hours.
“Child abuse” includes:
1. Physical abuse/injury (P.C. 11165.4)
2. Sexual abuse and/or exploitation (P.C. 11165.1)
3. Emotional abuse or willful cruelty (P.C. 11165.3)
4. Neglect (P.C. 11165.2)

“Elder abuse” includes (P.C. 368):
1. Physical or sexual abuse
2. Neglect
3. Financial abuse
4. Psychological abuse
5. Self-neglect
• If the counselor has reasonable cause to believe that you could possibly be dangerous to yourself or to the person or property of another, he/she will report this concern to the appropriate authorities or individuals.
3.) Notes are kept about your counseling session. The information is limited to dates, times, and any pertinent information regarding major areas of concern or safety. The notes are electronically stored in a secure database with access only given to the counselor and the Ministry Director.

Resolution of Conflicts:

On rare occasions a conflict may develop between a Christian Counselor and a counselee. In order to make sure that any such conflicts will be resolved in a Biblically faithful manner, we require all of our counselees to agree that any dispute that arises with a Christian Counselor or with Bayview Church as a result of counseling will be settled by mediation to take place with the following steps:
First, with the Purpose Pastor
Secondly, with the Purpose Pastor and the Ministry Director
Lastly, with the above mentioned and Sr. Pastor who will make the final decision

Agreement:

By signing this consent, you acknowledge and agree:
1) That you have read this Consent Form and agree to abide by the principals and policies of Bayview Church Christian Counseling Ministry as outlined above.

2) That you have had the opportunity to ask questions and gain clarification from a Bayview Christian Counseling Ministry Volunteer regarding this Consent Form.

3) That you are seeking, and Bayview Church is providing Christian Counseling. Bayview Church has informed you that it does not and will not provide any form of professional mental health counseling.

4) That you will not attempt to subpoena or require any Bayview Church Christian Counselor to appear in any legal proceeding related to any matters discussed during counseling; nor will you attempt to subpoena any notes or records related to this counseling.

5) That for safety and security purposes and to maximize the counseling experience, children of any age are not allowed in counseling sessions or in the waiting areas unless they are taking part in the counseling experience.

Having clarified the principles and policies of our counseling ministry, we welcome the opportunity to minister to you in the name of Jesus Christ. We desire to be used by Him as He helps you to grow, mature and transform into the individual He wants you to become. If the principles and policies outlined above are acceptable to you, please sign below by typing your name.

Sign by Typing Your Full Name:*

Date:*

Date

Referred By:*

*COUPLES ONLY (Married or Pre-Marital), where applicable please complete separate fields for each person.

Name (Individual Request or Person #1 for COUPLES):*

First NameLast Name

Phone Number:*

Area CodePhone Number

Email:*

example@example.com

Gender:*

Age:*

Marital Status:*

Do you have any children?*

Please share names and ages of children:

Occupation:*

Are you a member of Bayview? *

Have you completed Bayview's GET F.I.T. courses? *

Are you a member of an IMPACT Group?*

Have you accepted Jesus Christ as your personal Savior? (Briefly explain)*

What challenges have motivated you to request Christian Counseling?*

Have you previously received counseling for the above mentioned? (Briefly explain)*

What are you expecting to receive from your Christian Counseling experience?*

Are there any other concerns we should know about? (Briefly explain)*

Please list all your available times for counseling (keep in mind, due to the availability of our counselor your times are not guaranteed):*

Our Christian Counselors are volunteers and use their personal time to meet with you. Please make every effort to keep your scheduled appointments! If you cancel two appointments in a row you will be asked to submit another Counseling Request when you are able to make time for your sessions.

Would you prefer In-person or Virtual Counseling Sessions? *

Name (Person #2 for COUPLES ONLY):

First NameLast Name

Phone Number:

Area CodePhone Number

Email:

example@example.com

Gender:

Age:

Occupation:

Marital Status:

Pre-Marital Request (ONLY) Please list wedding date.

Do you have any children?

Please share names and ages of children:

Are you a member of Bayview?

Have you completed Bayview's GET F.I.T. courses?

Are you a member of an IMPACT Group?

Have you consulted with your IMPACT Group regarding your specific concern/need?

Have you accepted Jesus Christ as your personal Savior? (Briefly explain)

What challenges have motivated you to request Christian Counseling?

Have you previously received counseling for the above mentioned? (Briefly explain)

What are you expecting to receive from your Christian Counseling experience?

Are there any other concerns we should know about? (Briefly explain)

Please list all your available times for counseling (keep in mind, due to the availability of our counselor your times are not guaranteed):

Our Christian Counselors are volunteers and use their personal time to meet with you. Please make every effort to keep your scheduled appointments! If you cancel two appointments in a row you will be asked to submit another Counseling Request when you are able to make time for your sessions.

Would you prefer In-person or Virtual Counseling Sessions?