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Counselee Registration Form

Anchored Biblical Counseling

Register For Services
At Anchored Biblical Counseling, you’ll find counselors who reflect Christ’s grace—listening with compassion, guiding with Scripture, and walking beside you toward emotional and spiritual wholeness.

“The Lord is near to the brokenhearted and saves the crushed in spirit.” — Psalm 34:18

First name

Last name

Phone

Gender

Birthday

Month

Day

Year

Please state your current City / State

Where do you attend church? (Name, & City/State)

Session Requested (For Marriage & Family sessions, each person should fill out their own registration form unless they are a minor.)

Type of Visit

Reason for Counseling. Please provide a brief description of why you are seeking counseling.

Are you requesting counseling for a minor (under 18)

Yes

Minor DOB (if applicable) MM/DD/YY

Do you have a preferred counselor?

Biblical Counseling: I understand Counselors are trained Christian Counselors and are not licensed psychologists, psychiatrists, medical doctors, or clinical therapists. I understand that counselors do not diagnose medical or mental health conditions, provide clinical treatment, or prescribe medication. These services are not a substitute for licensed professional care.

Emergency & Crisis Understanding: I understand this ministry does not offer emergency or crisis services. If I experience suicidal thoughts, mental health crisis, or immediate danger, I will contact 911 or a licensed crisis provider. I accept full responsibility for my emotional, mental, and physical well-being.

Voluntary Participation: I am voluntarily seeking biblical counseling and understand that I assume all responsibility for decisions and outcomes resulting from these sessions. I agree not to hold this ministry or its counselors legally liable for any outcomes related to the counseling provided.

Full ABC Agreement, Disclaimer, & Privacy Policy

Counselee Registration Form

Anchored Biblical Counseling

Register For Services At Anchored Biblical Counseling, you’ll find counselors who reflect Christ’s grace—listening with compassion, guiding with Scripture, and walking beside you toward emotional and spiritual wholeness.

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“The Lord is near to the brokenhearted and saves the crushed in spirit.” — Psalm 34:18

Register For Services
At Anchored Biblical Counseling, you’ll find counselors who reflect Christ’s grace—listening with compassion, guiding with Scripture, and walking beside you toward emotional and spiritual wholeness.