CBC Biblical Counseling Pre-Counseling Questionnaire

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CBC Biblical Counseling Pre-Counseling Questionnaire

Thank you for contacting Mt. Vernon Community Bible Church for biblical counseling. We sincerely believe that God can work in your situation as you consider and respond to His Word, the Bible. Please complete this form to help us understand your situation so we can best serve you. This information will be held in confidence according to our confidentiality policy. Contact Pastor Dennis Fulkerson at dennis@mvcbc.org with questions. Thank you.

Name *

Email address *

Phone number *

Age *

Occupation *

Please describe the problem(s) or issue(s) for which you would like biblical counseling. *

How long has this issue presented itself? When/how did it begin? *

How has this issue affected you or impacted your life? *

What do you think is the underlying cause of the issue? *

Have you sought counseling in the past? If so, from whom? What was the outcome? *

What are your expectations in seeing a biblical counselor at this time? What do you hope to accomplish? *

Have you ever had counseling or psychotherapy before for any reason? If so, when and for what reason? *

Please describe your overall physical and mental health. Are there any significant health concerns? *

Have there been any recent changes to your physical or mental health? If so, what? *

Are you currently taking medications? If so, which ones and for what purpose? *

Please briefly describe your family history: upbringing, marital history, children, living situation, etc. *

Please describe 2 or 3 major events in your life that have impacted you most. *

What would you say you are desiring most at this point in your life? *

Please give 3 words to describe how you feel about life at this moment. *

Please describe your relationship with God and how you relate with Him. *

Please describe your devotional life. Do you pray, read the Bible, and/or have regular devotions?

How do you hope or believe the Gospel of Jesus Christ might affect your situation? *

Do you have a church home? If so, what is it? How are you involved? *

Are you willing to: *

Faithfully attend your biblical counseling sessions?

Diligently do assigned homework?

Be honest with God, yourself, and your biblical counselor?

Pursue God's transformative work in your mind, heart, and life?

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