Request for Counsel

If you are interested in receiving biblical counseling from one of our counselors at Cornerstone, please fill out this form. You will be entered in a waiting list, and they will contact you as soon as there is an opening. Your information and request are kept confidential.

Name

*

Email

*

Phone

*

Address

*

Best way to Contact You?

*

Please select one option.

Text Phone Email

Please briefly describe why you are seeking counseling.

*

Do you attend a church?

*

Please select one option.

Yes No

If so, which church?

Have you sought counsel there?

*

Please select one option.

Yes No

If so, with whom?

How did you hear about us?

*

Please select all that apply.

Friend ACBC Website Cornerstone Website Church Referral Other

If other, please explain.

Any additional questions or comments?

We are in the process of updating our forms. Please disregard the following section and go ahead and click the "Submit" button. Thank you!

Please upload your PDI from the link above.

Upload (8MB)

Please upload your Consent to Counsel from the link above. (Alternatively, you can upload both in one file above.)

Upload (8MB)

Description

If you are interested in receiving biblical counseling from one of our counselors at Cornerstone, please fill out this form. You will be entered in a waiting list, and they will contact you as soon as there is an opening. Your information and request are kept confidential.

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