Counseling Intake Form

Thank you for your interest in receiving biblical counseling. Our weekly counseling appointments are offered in-person in our offices located in either Lafayette or West Lafayette, Indiana. In order to prepare for your first visit, we need you to complete the following Counseling Intake form.

Content & Sections

The Counseling Intake form is divided into three main sections:

1. Personal Data Inventory

  • Contact Info
  • Health History
  • Religious Background
  • Marriage History
  • Children Info

2. Basic Information Questionnaire

3. Consent Form and Agreement

Time & Logistics

This form will take you approximately 20-45 minutes to complete. 

  • You are encouraged to complete it in one setting.
  • But you do have the option to Save and Resume.

If you decide to Save Answers and Resume Later, you'll be given a link to use when you're ready to continue completing the form. 

  • Be sure to copy the link and save it in a safe place. You'll be able to use that link from any computer anytime within the next 30 days to resume answering questions on the form. 
  • Without the link, the data you have entered cannot be retrieved and you will have to start filling out the form at the beginning.
Begin the Counseling Intake Form