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PHCC Intake Form
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Email
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Your email
Full Name
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Your answer
Please explain why you are seeking counseling. You don't have to provide each and every detail. However, please do provide enough information for the counselor to understand why you want an appointment and to pray beforehand.
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Your answer
Marital Status
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Education Level
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Briefly (1 sentence or 2) describe your relationship with Christ.
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