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Small Voice Ministries
Home
I'm New Here
What We Do
Resources
Testimonies
Contact
Donate
Client Intake Form
Name
*
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
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Email
*
Age
Gender
Male
Female
Marital Status
Married
Divorced
Widowed
Single
Briefly describe the reason for seeking coaching::
What is your religious affiliation, if any?
How long have you been a Christian?
What church or faith community do you belong to, if any?
Do you have a regular prayer practice? If so, please describe.
Do you have a regular scripture reading practice? If so, please describe.
Do you currently participate in any spiritual or religious activities, such as attending church or Bible study? If so, please describe.
Have you ever received counseling or coaching before? If so, please describe.
Do you have any mental health concerns or diagnoses, such as depression or anxiety? If so, please describe.
Have you ever experienced any trauma or abuse? If so, please describe.
What are your goals for spiritual growth and transformation?
How committed are you to making changes in your life?
Confidentiality Agreement: All information shared during coaching sessions will be kept confidential, except in cases where I may be a danger to myself or others, or where required by law. I agree to respect the confidentiality of my coach and other coaching clients.
Thank you!