Counseling Request

Please complete all fields.

First Name

Last Name

Phone

Gender

Nature and purpose for counseling session?

Describe what are your advanced expectations

Describe the particular issue or issues

How have I/we dealt with the issue or issues in the past?

Comments

What is your preferred mode of counseling?

Rules of Engagement

As the Pastor, I will not engage or continue any counseling until and unless I am satisfied of the following:

That it is worth the effort
That there is a willingness for you to change and align your behavior to spiritual advisement
That you are serious in following directives to its potential outcomes
That you consider attending our Corporate Gathering (CG) for a determined and agreed period during the sessions if, where, or when possible.
That assignments will be voluntarily pursued and advice followed
That there is mutual trust and respect
That truthfulness be expressed or exercised and sincerity is exhibited

*Only after the above assurances will I consider it. Those will be my conditions, the rest is up to you.

Acceptance of Rules
I do understand and accept the Rules of EngagementI do not understand and therefore cannot accept the Rules of Engagement

Pledge of Commitment to the Process

I hereby promise to abide by all aspects of the engagement policy / program and rules in the belief and for the betterment of finding biblically-relevant solutions when and where necessary, strategy when and where applicable and advisement on measurable and observable changes. I further promise to be supportive, committed and well-behaved, within the established counseling environment with the aim of cooperating and contributing to process requirements that lead to an eventual and successful outcome.

Acceptance of Pledge
I do accept the Pledge of CommitmentI do not accept the Pledge of Commitment

Counseling Request

Rules of Engagement

Pledge of Commitment to the Process

Address

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