Pastoral Counseling @ NorthField Church

Please fill out this short intake form. All submissions are kept confidential.

Your name *

Email address *

Phone Numbers *

Please list contact numbers and names for ALL persons who will be in our session

Please select the option that most closely describes your reason for seeking counseling *

This is a safe place to be in whatever season you find yourself in! (All Submissions Confidential/Check all that apply)

Blended Family Counseling

Couples Counseling

Divorce Counseling

Family/Group Mediation

Pre-Marital Counseling

Sexual Addiction Counseling - Men Only

Substance Abuse Counseling

Counseling for Life Issues/Other

Other

*DISCLAIMER

By submitting this form, I acknowledge that the NorthField Church pastors are not professional or licensed counselors, therapists, or psychiatric practitioners. I understand that I may be referred to another counselor at the end of our session. I understand that I am here voluntarily and that I am under no financial obligation to pay for services. I understand that no recommendation will be made for medical treatment, including prescription medicine. This is a matter between myself and my physician.

Joshua Woodlief or another NorthField Church pastor is an encourager in the Christian faith, who is helping me find freedom in Christ. I understand that everything I share during this experience will be kept confidential. I am also aware that intervention will occur if there is suspicion that a child (under 18yrs) or elder (over 65yrs) is currently endangered by abuse. Intervention will also occur if I am a danger to myself or others.

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