Christ-based Counseling, Intake Form
Counseling Intake Form (You have requested counseling.  This information is required to begin):
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Email *
First and Last Name *
Address (Street and Number) *
City *
What's your email address? *
Phone number or WhatsApp? *
Age
Sex *
What do you seek counseling for: *
If more than one issue (place them below):
Please briefly discuss your situation: *
Are you presently receive counseling, psychological, or sociological care?  if so (please provide the name).
Notice: This is counseling based on your religious faith. You agree that you are entering the counseling of your own accord.  And any faith or Christ-based insights, you have the choice to decide.  Concerning the counseling sessions, you will not hold Amazing Things The Church any of its auxiliary ministries, Dr. Steven DavidSon, or any associate counselor responsible for the choices you make.  Any decision is purely upon your level of faith and as an adult.  You further understand that each and all sessions or activity are under the complete authority of the counselor, and the counselor with notice, may make any necessary decision concerning counseling activities. If agreed, type your name and yes below: *
Please enter the date your completed this form below:
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A copy of your responses will be emailed to the address you provided.
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