Calvary Chapel West Houston Biblical Counseling

Personal Information

Name

Age

Sex

Address

Cell Phone

Home Phone

Work Phone

This address will receive a confirmation email

Have you received counsel from CCWH before?

Yes No

If yes, from whom?

Family Information

Marital Status

Single Married Widowed Separated Divorced

Name of Spouse (or N/A)

Age of Spouse

Date Married

Names of Children (or none)

Spiritual Information

Do you believe Jesus Christ is The Son of God and Savior?

How long have you been a believer?

Do you pray to God?

Regularly Occasionally Never

Do you read the Bible?

Regularly Occasionally Never

Briefly state your views regarding the authority of the Bible and its place in your life:

Do you attend Church?

Yes No

What services?

How often do you attend church?

Weekly Occasionally Rarely

Is Calvary Chapel West Houston your home church?

Yes No

If not, what church do you attend? (or n/a)

Do you serve in any volunteer area of ministry?

Yes No

If yes, where? (or no)

Do you attend a weekly Bible study or home fellowship? If yes, where?

Briefly describe your reason for seeking Biblical counseling:

I understand that Calvary Chapel West Houston offers Biblical guidance; therefore I agree to submit to the authority of the Bible as the standard for the resolution of my issues. I understand that I am not seeking nor receiving professional paid counseling, but I am asking for Biblical, spiritual advice. I understand that confidentiality of this situation will be maintained; however, counselors may be required to discuss certain issues with the pastoral staff. I understand that Calvary Chapel West Houston reserves the right to inform the proper authorities in cases of imminent danger or child abuse. Please sign (type full legal name)

Date

Calvary Chapel West Houston Biblical Counseling

Description

Please Fix the Following