Work Entry

Pastoral Guidance Intake Form

Are you looking for individual or couples guidance?

Individual Couples

First Name

Last Name

Phone

Email

How long have you been coming to Grace?

Which campus do you attend?

Is there a specific pastor/staff you would like to meet with? Why?

Are you currently involved in any groups?

Yes No

Are you currently in counseling?

Yes No

Have you had counseling in the past?

Yes No

What are the main things you would like to discuss with us?

Submit