Counseling Individuals Questionnaire

Our Purpose:
The purpose of the Care Team ministry is to, in a non-professional setting, help people overcome hard times through encouragement, prayer, and the power of God’s Word.

Once you fill out this initial questionnaire, our team will contact you to discuss counseling options. The Care Partners meet with individuals for a maximum of six, 45-minute sessions.

Romans 15:1-2, We who have strong faith ought to shoulder the burden of the doubts and qualms of others and not just go our own sweet way. Our actions should mean the good of others—should help them to build up their characters.

Galatians 6:2, Bear one another's burdens, and so fulfill the law of Christ.

Your name *

Last name

Email address *

Phone Number *

Phone type

What is your preferred method of communication? *

Phone Call

Text Message

Where is your primary Mosaic Church campus?

Ocean Springs

Harrison

Internet

Birthday

Gender *

Marital Status *

What is your availability to meet? (for example: anytime, evenings after 5:00, Tuesday afternoons, etc.)

What problems and challenges are you facing? *

What are your expectations in coming here? How are you hoping to change and grow? *

Are you currently attending Mosaic Church? If yes, for how long? *

Would you consider yourself a follower of Jesus? *

Yes

Are you involved in a Community Group? *

Yes

Personal Agreement *

I understand that notes from my counseling sessions will be kept in a secure program. These notes are private and will only be seen by the Care & Life Change Pastor and his administrative assistant, who helps with organization and confidentiality. I also understand that confidentiality has the exception of mandated reporting in situations where there is risk of harm to self or others.

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Mosaic Church
info@mosaicgc.com
228-875-3500

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