Intake Form

First Name

Last Name

Phone Number

What church do you attend?

Marital Status

Is your spouse/significant other aware that you have reached out for counseling?

Do you have children?

If yes, please provide their first names and ages:

Please describe the burden/need your family is facing and why you desire Biblical counseling:

How long has this issue existed?

What have you previously done to address this issue?

Please share what you specifically desire to happen through beginning these counseling sessions?

Have you trusted Jesus Christ as your Savior? Yes/No

If yes, please explain:

New Life counselors are primarily acting as disciplers and encouragers, committed to speaking God’s truth in love to you. We intend to lovingly partner with you through the following:

Biblical Relationship: Counseling is a relationship between counselor and counselee(s). We will grow together as we practice Galatians 6:2.

Biblical Accountability: The Bible affirms the need for accountability throughout its whole. Accountability in counseling is a needed relational component to ensure the issues resulting in the need for counsel do not become reoccurring - functionally practicing Proverbs 27:17, Ecclesiastes 4:9-12, and Galatians 6:1-2.

Biblical Sustaining and Healing: Empathizing with your suffering and encouraging you to see your life and circumstances from a biblical perspective

Biblical Reconciling: Creating healing by applying biblical truth to potentially hurting or broken relationships

Biblical Strategy and Guidance for Change: Examining and/or exposing your current responses to life and suggesting new ways of handling problems by equipping and empowering you to practically and spiritually mature in Christ

By typing your name below, you acknowledge that all of the provided information is true to the best of your present knowledge, and you further understand and agree with the position of New Life Counseling as described above.

Please type your first and last name: