General Christian Counseling Form

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General Christian Counseling Form

Full Name*

Phone*

Email*

Address*

Please list any prescription medications (dose, frequency) you currently take?*

Email Address

Have you had previous counseling? If yes, please give the name of the therapist(s), the year(s) you saw them ?*

Please check primary reason(s) for seeking counseling:

All payments are due the day before your scheduled appointment. If no payment has been made your appointment will be automatically cancelled. Cancellations If you are unable to make your scheduled appointment, please contact Covington-McGee Christian Counseling within 24 hours of your appointment. Once your appointment has been confirmed .There is a $ 35.00 cancellation fee for all appointments that are not cancelled within 24 hours of their schedule time. All services are non-refundable no exceptions.*

I understand ?

What do you hope to achieve from counseling?*

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