Pastoral Counseling Request
Please fill out this short form to help our administrative office serve you better in your spiritual counseling needs. We also ask that you take a moment and read the counseling disclaimer below:

COUNSELING DISCLAMER:
Completing this request form affirms your knowledgement and adherence to the following conditions for counseling with Pastor and/or Lady Rouson.

1. Any sessions conducted by Pastor and/or Lady Rouson are considered "spiritual counseling" and are not to be categorized as clinical psychotherapy services.

2. As such, there is no fee for spiritual counseling. Furthermore, pastoral counseling is considered a part of pastoral care for partners of the ministry. However, donations may be made if the counselee decides at will.

3. You do have the opportunity to request counseling with either Pastor or Lady Rouson individually; however, they each reserve the ethical right to include one another in the session or to apprise one another of the nature of the session(s) for pastoral accountability.

4. Due to Lady Rouson's secular career, requests to have both Pastor and Lady Rouson facilitate TOGETHER may require additional time or may need to occur at certain times (evenings, weekends, etc.). We ask your patience.

5. All pastoral counseling is considered confidential and its contents will not be divulged.

6. Due to the safety and health concerns because of COVID-19, we encourage virtual counseling, although in person sessions may be granted if needed. However, Pastor and Lady Rouson do reserve the right to make any session virtual if needed, so long as proper notification is given to the requestee.

7. Completion of this REQUEST does not automatically equate to a booked counseling session. Our team will confirm next steps if counseling will occur.
Sign in to Google to save your progress. Learn more
Email *
Your Name *
Your phone number *
Are you a partner of The Place of Change?           (you do NOT have to be) *
Would you PREFER... *
Please specify the nature (reason) of your request for pastoral counseling *
What is the best time of day for you to meet? *
Required
If tentative date and time has already been selected, please state it below for verification. If one has not been selected, you will have an opportunity to do so.
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of The Place of Change. Report Abuse