Littleton Bible Chapel - BC Counseling Request Form

Check the category for which you are seeking support and/or intervention
Individual counseling
Marital or family counseling

Identify and describe your concerns and needs:

What circumstances are leading you to seek support/help?

What are you seeking from this ministry?

Describe your current relationship with the Lord:

What other information do you think would be helpful for us to know:

Do you currently attend LBC? If not, how did you hear about the LBC Counseling Ministry?

First Name

Last Name

Email

Phone Number

Birthdate (Month/Day/Year)

List days and times that work best to meet

Counseling Request