Counseling In-Take Form

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Introductions

Dear Friends,

We are delighted and encouraged that you are interested in participating in Biblical counseling at Glenn View Baptist Church.

As part of our ongoing counseling ministry, we have attached our guidelines (Counseling Agreement Form) that apply to everyone who seeks counseling at our church. These guidelines form the basis of our mutual commitment to Biblical counseling. We’ve also attached a Personal Data Inventory (PDI) form which, when completed, will help us in our initial efforts to get to know you and your situation. Please fill out this form completely.

If you agree with the principles and guidelines set forth in the agreement, please sign and date it at the bottom of the form. All your information will be kept confidential within our staff.

During our first session together, one of our counselors will review the information in your documents, answer any questions you may have regarding the Counseling Agreement and process, and determine the general issues and direction to be taken in your counseling. Following this session, we will ascertain which of our counselors will meet with you in subsequent sessions and on what schedule, should you decide to continue with us.

We look forward to working with you in the near future.


Blessings to you,

GVBC Staff
Counseling Agreement

If you are interested in receiving Biblical counseling at Glenn View Baptist Church, please read and sign the following statement.

The Biblical counselors at GVBC are available to take a limited number of counseling cases. Our counselors (by design) are not certified by the state of North Carolina; rather, they have received or are receiving extensive training in Biblical counseling. Our counselors are not trained or expected to administer or monitor medication, nor can we modify physician recommended medical decisions.

If you seek counseling at GVBC, we want you to know that all counseling will be conducted in accordance with the counselor’s understanding of the Scriptures. Your counseling will be Biblical, meaning that the Bible will be the authority in all cases. If you are not sure that you will be interested in Biblically based counseling, you may first attend one or two sessions to better understand what Biblical counseling is like. If you are unwilling to use the Bible as the final authority or are unwilling to do the assigned homework, the sessions will be unproductive and therefore potentially terminated. We will, however, give our best efforts to direct you to a proper counselor to meet your needs.

If you attend a church other than GVBC, we encourage you to invite your pastor, small group leader, deacon, or another leader from your church to accompany you to the counseling sessions. We recognize and respect the authority and discipline of your church. The attendance by your pastor or other leader will make the transfer back to the pastoral care of your church much easier.

If you are not attending a church, or if your pastor or another leader from your church does not accompany you to the counseling sessions, or if your church is not structured or willing to provide the kind of counseling received at GVBC, we hope you will attend GVBC on a weekly basis while you are in counseling here. Lasting change is more effectively realized when people also receive help from the church’s ministry of preaching, teaching, and fellowship and when those ministries complement the help given in counseling.

Confidentiality is practiced in our counseling sessions; however, absolute confidentiality is not Scriptural. In certain circumstances, the Bible requires that facts be disclosed to select others (Matthew 18:15ff). If your church leadership should inquire, we will disclose to them only the information that we believe is necessary for them to effectively and Biblically fulfill their responsibility to shepherd you. If you have a problem with this procedure, please discuss your concerns and reasons for those concerns with your counselor.

At any time during the counseling, either the counselor or the counselee—for reasons sufficient to himself or herself—shall have the option of terminating the counseling.

GVBC currently does not charge a fee for counseling. However, there are costs associated with maintaining this ministry. If you would like to express your appreciation and make a contribution, please make donations to Glenn View Baptist Church (counseling ministry), not to the counselor. Also, you may be required to purchase homework materials in the course of counseling.

Biblical counseling involves giving Scriptural teaching and making practical application to the counselee. The counselee is held fully responsible for how he implements that counsel. Glenn View Baptist Church is also committed to training Biblical counselors. This means that one or two people may sit in the sessions with the counselor for training purposes.

We are confident that the Bible has all the information necessary for life and godliness (2 Peter 1:3). There are no problems between persons or in persons that the Bible fails to address either generally or specifically. Our counselors are not infallible, nor do they pretend to know all there is to know about Biblical teaching and its applications to life. But they are well-equipped and competent to help people change. They will make a point to differentiate between God’s commands and their suggestions. Counselors will also honestly tell you if they are stymied and will seek help. Please note that we do not give medical or legal advice.

If a conflict should arise between the counselee and the counselor, both parties agree to resolve the dispute outside the secular court system. Conciliation will be sought under submission to and at the direction of the elders of Glenn View Baptist Church, Winston Salem, NC.

If you are willing to enter into this kind of counseling, please sign below this form, along with your completed PDI.

I have read the conditions for counseling set forth in this document and agree to enter into counseling in accordance with them:
 
 
 
 
 
PERSONAL DATA INVENTORY (PDI)

Identification Data

 
 
 
 
 
 
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Medical History

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Religious Background

 
 
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Personality Information

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Marriage and Family Information

 
 
 
 
 
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Occupational History

 
 
 
 
 
 
 
 
 
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Description

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