Counseling Application

First Name

Last Name

Street Address

Email

Phone Number

May we text you on this number?

Yes No

Gender Demographics

Male Female

Age Demographics

0-4 5-11 12-17 18-30 31-40 41-50 50-64 65+

Military Status

Active Duty or Reserves Veteran Military Spouse None of These

Do you attend TFH?

Our goal is to connect you with counseling from one of our local campuses. What campus would you prefer to receiving counseling resources from?

How many years have you attended TFH? How many times a month do you attend a weekend service?

Which service do you primarily attend?

Have you been Saved and/or Baptized

I believe Jesus is my Savior I have been Baptized

Please list any TFH Groups you currently attend:

It is a requirement to be a part of a TFH Group before receiving Common Care Counseling

Please list any TFH Ministries you are currently involved with:

Are you currently attending or have you attended any of these ministries?

Please indicate any areas you struggle with: (Select top 3)

Are you currently in professional counseling?

Why are you seeking Counseling?

Please give a brief description of the situation & history related to why you're seeking counseling:

What steps have you taken to date?

What do you hope to achieve through counseling?

Current Living Situation (Select All That Apply)

Alone Parent(s) Spouse Children Boyfriend Girlfriend Grandparent(s) Other

What is the name of your spouse?

What is the age of your Spouse?

Have you and your spouse been separated?

Have you previously been married?

Do you have children? If yes, please list age & gender

The Father’s House Counseling programs are geared toward short term counseling with long term connections in small groups and/or ministries. Please explain how you heard about the counseling program/how you are connected to The Father’s House:

Submit

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