COUNSELING INTAKE FORM FOR PARENTS

Welcome to the counseling ministry at Harvest Bible Chapel North Indy. We know it’s not easy to ask for help and we are so grateful that you have invited us into your life at this time. It is our prayer that God will bless you and use our time together to build more hope and direction into your life.

The next step in the counseling process is to complete the following intake form. This form is designed to (1) help us to get to understand your family in a more comprehensive and holistic manner (2) help you organize your thoughts about your counseling objectives and (3) help establish the guidelines of commitment and confidentiality between you and your counselor.  

Rest assured that this form will only be given to your assigned counselor and all information will remain confidential. Please allow approximately 30-45 minutes to complete these forms. 

Please read and answer this form carefully. Simply put “NA” if the answer is not applicable to you.

Parent's Information
PARENT NAME *
PARENT NAME
GENDER *
Address *
Address
Phone *
Phone
Family Information
Child's Information

CONSENT TO BIBLICAL COUNSELING:
Note: A consent form will be sent to you via email to complete for all parents and children involved in the counseling process. Please bring those completed forms to your first meeting.