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Christian Counseling Session Form
Personal Information
Name: _______________________________________
Date: _______________________________________
Phone Number: _______________________________
Email Address: _______________________________
Preferred Method of Contact: ___________________
Age: ______
Marital Status: _______________________________
Session Information
Session Number: ________
Counselor's Name: ___________________________
Location: ___________________________________
Date and Time of Session: _____________________
Initial Questions
What brings you to counseling today?
Describe your current relationship with God.
What are the main issues or challenges you are facing?
Have you sought help from others (friends, family, pastors) for these issues? If so, how?
Spiritual Background
How often do you pray?
☐ Daily
☐ Weekly
☐ Occasionally
☐ Rarely
☐ Never
How often do you read the Bible?
☐ Daily
☐ Weekly
☐ Occasionally
☐ Rarely
☐ Never
Are you part of a faith community or church? If so, how involved are you?
Describe any significant spiritual experiences you have had.
Emotional and Mental Health
How would you rate your current emotional well-being?
☐ Excellent
☐ Good
☐ Fair
☐ Poor
Have you experienced any of the following? (Check all that apply)
☐ Depression
☐ Anxiety
☐ Stress
☐ Grief
☐ Anger
☐ Other (please specify): ______________________
Are you currently taking any medication for emotional or mental health?
☐ Yes
☐ No
Have you seen a mental health professional before?
☐ Yes
☐ No
Goals for Counseling
What do you hope to achieve through counseling?
Are there specific areas you want to focus on in your sessions?
What steps are you willing to take to address your issues?
Session Notes (For Counselor Use Only)
Key Issues Discussed:
Scriptures Shared:
Action Steps and Goals:
Follow-Up Date:
Signature
Counselee's Signature: _______________________________________
Date: _______________________________________
This form will help structure the counseling session and ensure that important information is captured, aiding in providing effective, focused, and compassionate care.