Pastoral Counseling Request

PASTORAL COUNSELING CONSENT FORM

1. What is Biblical/Christian Counseling? Biblical Counseling, sometimes known as Pastoral Counseling, has as its center the Lord Jesus Christ. It is counsel which:

a) Includes listening, teaching, encouraging, preparing, comforting, warning, admonishing.

c) Has as its purpose to glorify God and to guide the counselee into an increased understanding of his/her personal, love, grace-oriented relationship with Jesus Christ.

d) Will result in pursuing a transformed life that reflects God’s grace, glory, and joy.

This type of counseling is in contrast to secular forms of counseling. Its goal is to

“Proclaim Him, admonishing every man and teaching every man with all wisdom, that we may present every man complete in Christ. And for this purpose also I labor, striving according to His power, which mightily works within me” (Col 1:28-29 NAS).

“Equip the saints for the work of service, to the building up of the body of Christ; until we all attain to the unity of the faith, and of the knowledge of the Son of God, to a mature man, to the measure of the stature which belongs to the fullness of Christ” (Eph 4:12-13).

2. Referrals to Professionals: If you have significant legal, medical or other technical questions, you should seek advice from independent professionals. Our pastoral and lay counselors will cooperate with such advisors and help you to consider their counsel in light of relevant scriptural principles.

3. Intent Listening: We encourage counselees to speak their mind in an appropriate fashion and to discuss thoughts, anxieties, and fears so the counselor will clearly understand core problems.

4. Assignments: Counselees progress more rapidly when they study or perform specific informational or behavioral assignments that are individually tailored to pertain to the problem.

5. Accountability: We desire to maximize use of your time and of the counselor’s time. One of our goals is to help believers learn how to glorify God, to have the outward life reflect the yielded, godly inward life, resulting in peace and joy. Therefore, it is important for each counselee to participate actively in the counseling sessions, in church, and in the homework between the sessions. As we are accountable to our God, to our Church, and to our fellow believers, so we ask you to submit yourselves to being accountable to the Lord and to the counselor for active participation and completing assignments. We also ask that you attend a Bible-believing Church service or study consistently.

6. Length of Counseling: Biblical Counseling will vary in the amount of time required, according to the individual, his/her motivation, the amount of time spent on homework, and the particular situation and/or problem. On average, Biblical Counseling requires less time than conventional, secular counseling. Simple problems may be solved in one session. Severe situations often require a longer period. When multiple people are involved in the counseling, as frequently happens in marriage counseling, more may be required.

Substance abuse and addiction problems may require many more sessions, with intensive accountability and

COUNSELING CONTRACT

I/We affirm the accuracy of the personal information provided herein, have read the information above, and agree to the conditions set forth therein. I hereby agree to the following conditions:

1. I (We) understand that the counseling I (we), my family, or those legally under my guardianship will receive will be based upon the Bible, with the goal of glorifying God and leading to grace-filled, godly living.

2. I (We) will keep the appointment time or will call prior to 48 hours to cancel with a legitimate excuse. In respect of my counselor’s time and preparation, as well as other counselees who could have had this time slot, if I fail to call 48 hours in advance (unless it is an emergency), I will pray about the amount the Lord would have me donate. Monies will not be refunded but applied towards the next appointment.

3. I (We) will fulfill the weekly assignments or the session might not be held.

4. I (We) will seek to consistently attend a Bible-believing, teaching and practicing church while I am (we are) in counseling, and, preferably, at least one other Bible teaching study/service during the week.

5. I (We) understand that confidentiality is an important part of the counseling process and my counselor is careful to protect confidentiality, desiring to operate under high ethical principles.

However, there are times when my counselor must share certain information with others, such as information is revealed which indicates a genuine potential for harm to you or to others. In that case, counselors may have to share that information with the appropriate authorities or family members, being obligated by conscience and by the laws of this state in regards to counseling relationships, being required to report to the appropriate authorities any information that raises suspicion of child abuse, intent to harm oneself, and/or intent to harm another person.

I understand my counselor(s) strongly prefer (s) not to disclose personal information to others and desire(s) to help me find ways of resolving problems as privately as possible.

6. Due to the litigious society, this counselor has been asked to have a release signed by each counselee as follows:

I (We) do hereby agree to hold all counselors affiliated with LoveGPS Inc. and DBA LoveGPS Counseling Services, LoveGPS and its leadership harmless from any advice, counsel, or suggestions rendered during our counseling sessions. We recognize that their role is to assist me/us in hearing and understanding

God’s will in the matters we discuss. We will not, therefore, sue or engage in any type of litigation negatively affecting them, LoveGPS Inc., LoveGPS Biblical Counseling Services, LoveGPS or organizations granting them the ability and resources to provide counseling services. Furthermore,

I/we agree not to attempt to subpoena or require any counselor to appear in any legal proceeding related to any matters discussed during counseling, nor will I (we) attempt to subpoena any notes or records related to this counseling.

7. LoveGPS Inc. is a faith-based ministry that depends upon generous contributions of its counselees, members and partners. Additional costs are underwritten by LoveGPS Inc. We encourage you to pray and ask the Lord what you should give. Each person is asked to contribute based on the suggested sliding scale below.

If you cannot offer that amount financially or in kind, if your Church refuses to help with a contribution, or if you have questions, please discuss with your counselor.

Checks or money orders are to be written to LoveGPS Inc.

Suggested Donation Amount

$50 existing clients

Sessions last 50-60 minutes.

8. I/We will purchase any books or materials for homework assignments that my counselor

9. Unfortunately, LoveGPS INC. is unable to provide childcare

PRIVACY POLICY:

All personal information submitted shall be kept private on LoveGPS Counseling & Church servers and shall not be used for any other purpose.

1st Person's Name *

1st Person's Phone Number *

1st Person's Email Address *

1st Person's Primary Address *

Country *

2nd Person's Name *

2nd Person's Phone Number *

2nd Person's Email Address *

2nd Person's Primary Address *

Other Person's That Will Be Attending Session

Emergency Contact Name *

Emergency Contact Phone *

1st Person: I Fully Understand and Agree With The Stipulations of This Faith-Based Counseling Consent Form *

Yes

No

2nd Person: I Fully Understand and Agree With The Stipulations of This Faith-Based Counseling Consent Form

Yes

No

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