Are you currently receiving counseling? *

Yes

No

Have you received counseling in the past? *

Yes

No

Have you ever had coaching? *

Yes

No

Have you ever been diagnosed with a mental illness? *

Yes

No

Is there past trauma you would like to work through and heal from? *

Yes

No

Do you struggle to find joy in daily activities and routine? *

Yes

No

Sometimes

Are you currently in an abusive/toxic relationship? *

Yes

No

Do you feel confident in your relationship with the Lord? *

Yes

No

Sometimes

Are you ready to be intentional in living out God's will in your life? *

Yes

No

Do you feel stuck and unsure of the next steps you should take? *

Yes

No

Do you struggle with boundary setting and follow through? *

Yes

No

Do you have a difficult time making decisions? *

Yes

No

Name *

First Name

Last Name