•  Confidential Intake Form

    Confidential Intake Form

    SCOPE MINISTRIES COUNSELING SERVICES
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     Welcome To SCOPE Ministries!

    Our Mission: To empower people and offer support and guidance as they discover how to reap the benefits of Biblical Counseling by applying the wisdom learned through Christ-centered education and a relationship with the Holy Spirit.

    Our Vision: For the world to rely on the grace and love of Christ for solutions in life.

    Our Values: We Value People, Christ-centeredness, Stewardship, and Effectiveness.  

     

    Embrace The Spirit-filled Life!!!

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    INFORMED CONSENT & HOLD HARMLESS AGREEMENT

    Scope Ministries International believes God provides His written word for guidance as to what a Spirit-filled life looks like, with the real focus being a relationship with Him. We believe this is accomplished by Holy Spirit-led counseling

    The staff members and group facilitators are not state-licensed counselors, partly because the state of Oklahoma does not license pastoral counselors, but also because they perform a different function. We are not "counselors" in the secular sense of the word. Instead of attempting to counsel individuals as to how they should conduct themselves, we teach the understanding of themselves from God's perspective, the character of God, and their relationship with Him. From this service, changes in thoughts and behaviors naturally flow. What we offer is Biblical ministry, as opposed to secular counseling.

    Our staff does not possess the ability to change your life or fix your problems. Greater understanding and a different approach to life come through participation with Holy Spirit.

    While careful listening and empathy are a part of our process, the type of ministry offered by Scope is not passive, but directive in nature. Homework will occasionally be assigned based on the teachings of Scripture. Assignments may include reading, Bible studies, videos, etc.

    Under normal circumstances, everything you discuss will be held in strict confidence. However, there are some situations where we may be required by law to report information without your permission or knowledge. These situations include, but may not be limited to (1) indication of bodily harm to others, (2) involvement in a felony, (3) suicidal intentions, and (4) knowledge of the child or elder abuse/neglect. We might also be required to disclose information in response to a subpoena issued by a court of law.

    Please be considerate and on time for your appointments. Any cancellations require a 24-hour notice or a full session fee will be charged. Because we are also a training center, a Scope Ministries International trainee may occasionally participate in the process. Trainees are subject to the same confidentiality guidelines as staff.

    Scope Ministries is an independent, inter-denominational, non-profit ministry. We ask all who receive ministry from Scope Ministries to read and sign this informed consent and to release Scope Ministries International, its agents, and employees from any claim arising from the undersigned's participation in Scope's ministry.

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    ********** FINANCIAL RESPONSIBILITY **********

     SERVICE FEES:

      • Intake Appointment - $65 
        **During this appointment, staff members may recommend that a client participates in one of the small groups that lay the foundation and/or supplement the counseling services. These classes may include "Be Transformed," "Boundaries and Communication," or other classes which have proven highly effective in helping clients resolve many of the conflicts for which individuals seek counseling.**

      • Pastoral Counseling & Biblical Life Coaching -  $65.00 / 50-min
      • Premarital/Marital Counseling & Biblical Life Coaching - $100 / 50-min
      • Couples Counseling (Not Married) & Biblical Life Coaching - $100 / 50-min 

     

    Fees Are Due When Services Are Rendered.

     

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    PAYMENT OPTIONS:

    SCOPE Ministries Accepts the following forms of payment:

    CASH | CHECK | CREDIT/ DEBIT CARD | AUTOMATIC DRAFT | PayPal 

     

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    FINANCIAL ASSISTANCE:

    Those who participate financially in the benefits they receive are more successful in achieving their related goals than those who do not participate.  However, we understand that not all clients receiving services have the ability to pay for such services. Because of our continued desire to not turn anyone away for financial reasons, we want to suggest the following for those clients who truly cannot pay:

    • We encourage counselees in need of financial assistance to seek financial sponsorship from family, friends, or their church.
    • We strongly encourage clients to personally contribute to paying for a portion of their own counseling, even if someone else is sponsoring them.

     

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    CHURCH SPONSORSHIP:

    SCOPE Ministries offers churches a new way to invest in the spiritual health and well-being of their church family through Church Sponsorship.

    NOTE: Church Partners receive a substantial discount on counseling fees. Please have your church contact us for more information.

    Church Partners: It is important to understand our confidentiality agreement remains in place unless a limited release form is signed by the client. Even then, when discussing client progress with a Church Partner, only general information such as whether the client is understanding the information, is applying it to their particular situation, etc. is shared.

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    DONATIONS: 

    I understand that Scope Ministries International is a nonprofit Oklahoma Corporation. SCOPE operates on donations, which are tax deductible. Amounts in excess of the counseling fee are tax deductible.

    Donations are the lifeblood that keeps us going - a vital resource without which we could not provide these lifechanging classes and services to the community and share The Word of GOD through our Ministry of Biblical Counseling, Christ-centered Educational Classes, and inspirational and enlightening selection of Christian Literature. 

    Your contributions are a blessing to us and those we serve. We thank you for your commitment to serving The Lord and supporting our mission through volunteering time and financial support. We pray that GOD's Light shine bright through us all so we might be a beacon of hope to those still struggling in the darkness and help to light the way so they might find salvation and comfort in HIS Grace.

    Sincerely,

    SCOPE Ministries International

     

    ACKNOWLEDGMENT

    I understand that SCOPE Ministries International is an Oklahoma Nonprofit Corporation. As such, SCOPE Ministries operates on donations, which are tax deductible. Additionally, amounts received in excess of the counseling fee are tax deductible.

    I have read the above information and understand the financial responsibility of the counselee (the recipient of services) at SCOPE Ministries International.

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    DISCLAIMER AND RELEASE OF LIABILITY

    I state that I have voluntarily sought assistance on my initiative and that I am under no obligation to accept or reject any of the information or guidance that I might receive from staff members of Scope Ministries International.

    I agree to hold Scope and its staff members free from any and all liability, loss, or damage of any kind which may arise as a result of the ministry which I have received, or from my involvement with Scope.

    I have read this Informed Consent, Hold Harmless Agreement, Financial Responsibilities Policy, and Disclaimer and Release of Liability, and I understand and agree with it and have executed it as my free and voluntary act.

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    ***Entering your name below serves as your electronic signature and, therefore, indicates that you understand, accept, and agree to comply with the information, terms, and conditions stated in the Informed Consent and Hold Harmless Agreement, Financial Responsibilities Policy, and the Disclaimer and Release of Liability.***

  • Tell Us A Little Bit About Yourself...

    Tell Us A Little Bit About Yourself...

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    *** If you are requesting couples counseling, EACH individual must fill out a separate Counseling Services Intake Form. ***

  • SCOPE Ministries Counseling Intake Questionnaire

    SCOPE Ministries Counseling Intake Questionnaire

    Check "Yes" or "No" to indicate whether the statement represents YOU... "MOST OF THE TIME".
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