Personal Data Inventory
Biblical counseling is applying the eternal truth of God's Word to the problems, dilemmas, suffering, and sinful decisions of man. Counseling happens every day in a variety of ways, but Biblical counseling happens when someone needing help is given solutions, instruction, wisdom, and exhortation from the Scriptures. We submit to the Scriptures as authoritative and sufficient in order to grasp man's problems and provide true solutions through the work of the Holy Spirit. Biblical counseling deals with the sin and suffering of the individual through the lens of a Biblical worldview. The ultimate cure for sin and suffering is a renewed love and worship for God, through Biblical instruction and the work of the Holy Spirit. 
To help us more efficiently discern what we can do to help, we ask you to fill out the following form and return them before your session. If you are coming as a couple or family, each family member should complete a form separately. (if under the age of 12 no form is necessary.) Thank you.  
After the form is submitted our office will be in contact with you to schedule an appointment. 
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Name *
Email Address *
Phone Number *
Home Address *
Occupation *
Business
Work Phone 
Date of Birth *
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DD
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Gender *
Who referred you to Flint Hills Biblical Counseling?
Marital Status *
What times are you available: Monday through Friday? 
Children and Ages? 
Do you have any physical or medical conditions? Please explain
What church do you regularly attend? Are you a member? 
Who are your two closest friends and why?
If you were to die tonight and stand before God and He asked you why He should permit you to enter heaven, what would you answer? 
Do you have a close Christian friend who, if needed could come with you to the counseling for support, encouragement, and accountability between sessions? 
Have you received counseling in the past? Who, when and for how long? Can you summarize what they believed the main problem to be and what they told you to do about it? 
What is the main problem/trouble as you see it? (i.e. What needs to change?) How long has this been going on?
What things do you think have contributed to the problem/trouble? Do you believe you have in some ways contributed to the problem/trouble? Explain.
Please describe anything you have done about this problem so far? What were the results?
What would you like us to do?

Flint Hills Biblical Counseling - Supported by Flint Hills Bible Church www.flinthillsbc.org

Form - Lowcountry Biblical Counseling Center www.lcbcc.org 

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