Skip to content

HOME
ABOUT
SYNERGIES
WATCH LIVE
CONTACT US

Menu

HOME
ABOUT
SYNERGIES
WATCH LIVE
CONTACT US

Facebook-square

Home

/

Request for Individual Counseling

By staffIn Ministry FormsPosted December 6, 20180 Comment(s)

You are not alone. When you need someone to talk to, we are here to offer Christian counseling that strengthens your faith. If you would like to make an appointment, please fill out the form below.

Today's Date

What do you need counseling for?

First Name *

First

Last Name *

Last

Email *

Home Phone Number *

Cellular Phone *

Best time to contact you? Home or Cell?

Have you accepted Jesus Christ as your personal Savior?

Yes

No

Are you a member of Fresh Wind?

Yes

No

How did you hear about our counseling services?

Do you belong to another church?

Yes

No

If yes, please provide your church's name and phone number

If yes, does your pastor know that you are seeking outside help?

Yes

No

If no, please explain why not?

Please provide your Pastor's Name and contact information

Are you under a doctor's care

Yes

No

If yes, what reason?

What medications are you currently taking?

Marrital Status

Number of children in the home and ages

In case of emergency, please provide contact information (Name, Telephone, Relationship)

FOR OFFICE USE ONLY

From

:

To

:

Consultation to take place at (Location)

Signature of Fresh Wind Ministries Representative

Date

Signature

Print Name

Date

Signature

Print Name

Date

If you are human, leave this field blank.

staff

Post navigation

New Members Class Registration

Request for Marital / Premarital Counseling

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Search for:

God doesn't need your help;
He just needs a face.
~ Apostle Paul Kelker ~

The Word is planted in heaven,
but I want it to be grown
by the time it reaches you.
~ Apostle Paul Kelker ~

If you don't have dominion,
you do minion.
~ Apostle Paul Kelker ~

Fasting shows the Kingdom
how hungry you are for God.
~Apostle Paul Kelker ~

COME JOIN US!

Twitter

Facebook-f

Youtube