Request Counseling

Counseling Request

Only individual counseling is offered at this time. Couples or marriage counseling is not available.

Submit this form to request counseling.

* Indicates required field

Name *

First

Last

Phone Number *

Email address *

Let us know what you're going through and how you think we may be able to help. Most importantly, make sure to mention why you are seeking spiritual help/biblical counseling, and what you hope to gain from it. *

Can you afford suggested $75 donation for each session? *

Yes No

If you said 'no,' tell us why you can't afford it, and choose a rate you can afford from the choices below. (Please note: We may ask you to share information about your income and monthly expenses.) *

Amount Requested *

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