From the follow list, please select all that apply to you and rate the severity from 1 (infrequently present) to 5 (always present). Use the comment section below to explain in more detail, if necessary.
Informed Consent & Counseling Disclosure
Please read the entire disclosure below, and mark that you understand the content before scheduling your counseling session. *
*All information contained in this intake form is strictly confidential and will not be shared beyond the counseling team at Sojourn Heights Church*
In an effort to make informed decisions about your counseling experience and expectations, the following paragraphs are provided in order to discuss pertinent information regarding your counselor’s background and qualifications as well as your responsibilities as a client.
“I, the undersigned, understand that any person I meet with for counsel through Sojourn Heights Church is not a licensed professional counselor. They will not be working toward a diagnosis as set out by the American Psychological Association. I have come seeking biblical counseling that will be conducted in a confidential setting."
If you have any questions or concerns regarding any of the policies or statements made within this document, please email Dods Pengra at firstname.lastname@example.org.
Your counselor’s method of counseling is based on biblical truth. As a Christian, biblical counselor they believe in the triune God of the Bible who sent the Son, Jesus, empowered by the Holy Spirit, to live, die, and be raised for the atonement of our sin. Our counsel is shaped by these principles:
1) It is rooted in God and His Word
2) It exalts Jesus Christ and His Gospel
3) It is empowered by the Holy Spirit
4) It is loving.
If you are willing, your counselor is eager to work with you, regardless if you share this view of God or counseling.
There is always a risk of emotional or relational turmoil that could result from counseling. Counseling can bring up painful emotions or memories, or it could expose hurtful and damaging patterns of sin (in ourselves and/or others). At times, feelings and situations can worsen before they improve. Our goal is to address these issues and emotions biblically; to work through them with truth and care in a timely manner.
While the length of counseling is difficult to predict, we recommend all who seek counseling to commit to no less than six (6) one-hour sessions with a counselor. Each individual (single or married) has unique strengths and weaknesses, gifts and sin, and each problem is unique in its own way. Counseling and growth take time. The goal is that each counselee will, with their counselor, determine an appropriate time to end formal counseling sessions.
Since your counselor is not licensed, they are not submitting directly to the ethics outlined by the Texas state board. However, they are submitting to God, the authority of the Bible, and the leadership of the local church to which they are covenanted. Therefore, any conduct by the counselor deemed inappropriate or sinful by God’s Word should be reported to one of the local pastors at Sojourn. Such behavior includes, but is not limited to: sexual innuendo, sexual contact, and inappropriate disclosure of personal information to others. If the conduct of your counselor is considered illegal by law, do not hesitate to contact the proper authorities.
Content of your counseling sessions is confidential. However, legally and biblically, there are several conditions under which your counselor should break confidentiality. They are listed as follows:
1. If you threaten to hurt yourself or someone else.
2. If you disclose any involvement in child abuse or child pornography.
3. If your conduct merits church discipline as outlined in the by-laws of your covenant community.
Should the counselee or counselor believe that a referral is needed, alternatives will be provided. A verbal exploration of alternatives to counseling will also be made available upon request. The counselee will be responsible for contacting and evaluating those referrals and alternatives.
Thank you for taking the time to complete the Sojourn Heights Soul Care Intake Form.
Once you have completed the form in its entirety, your next steps are as follows:
1) Email Dods at email@example.com on booking your session.
2) Submit the requested Soul Care donation at Pushpay.com/pay/SojournHeights.
*The requested donation for Covenant Members of Sojourn Heights is $40. For non-covenant members, the requested donation is $90.