Counseling Request Form - Church at the Grove

Phone number *

Do you attend one of our Church at the Grove campuses? If so, which one? *

Are you a Church at the Grove Covenant Family Member? *

Yes

No

Are you requesting pastoral counseling for yourself or for someone in your family? *

I am requesting counseling for myself.

I am requesting counseling for someone in my family.

What pastoral care services are you requesting? *

Please check all that apply.

Addiction

Crisis Situation

Depression

Family Issues

Financial Issues

Grief

Life Transitions

Marriage

Pre-Marriage

Worry or Anxiety

Other

Briefly describe what the counseling is for? *

Our pastoral team is limited in the counseling they are able to provide, if the pastor feels that your issue or situation requires professional counseling, are you willing to pursue that? *

Yes

No