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Counseling Request Form
Please note that if you are in the region of Centurion or Krugersdorp, you will be required to consult your eGroup leader for counselling.
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* Indicates required question
Full Name and Surname
*
Your answer
Email
*
Your answer
Phone number
*
Your answer
Physical Address
*
Your answer
When did you first visit Encounter Church?
*
Your answer
Are you a member of Encounter Church?
*
Yes
No
Have you completed the Vision Track:
*
101 Encounter Invested
201 Freedom
301 Discover
401 Equip
501 Conquer
Have not started with Vision Track
Required
Are you in an eGroup?
*
Yes
No
What is your eGroup Leader's name?
Your answer
With whom do you want an appointment?
*
Your answer
Reason for wanting an appointment?
*
Your answer
Disclaimer
Please note this form is for online visitors and attendees only.
We will unfortunately not be able to accommodate requests for online counselling from physical attendees.
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