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Counseling Request
Our Biblical Counseling Ministry is led by Pastor Pam Ingold, Congregational Care Pastor, and a team of lay counselors. Please fill out this form and Pastor Pam will connect with you to get you started.
Your name
*
Last name
Email address
*
Confirm email address
*
I'm requesting:
*
Select…
Individual Counseling
Couple's Counseling
Youth Counseling
Pre-marital Counseling
Gender
*
Select…
Male
Female
Birthday
*
Date
Age
*
Address
*
Home
Work
Other
Country
Country
Street address
Apt/unit/box (optional)
City
State
Postal code
Phone Number
*
Phone type
Mobile
Home
Work
Other
Spouse's Name (if requesting couple's counseling)
Spouse's Email
Spouse's Phone Number
Spouse's Birthday
Date
Do you attend The Church at RB?
*
Select…
Yes
No
Please explain your reason for wanting to see a counselor
*
Best day(s) to meet (in general)
*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Best time of day to meet (in general)
*
Morning
Afternoon
Evening
What is your preferred way to receive counseling?
*
Zoom or in person are both fine
In person at The Church at RB
Through zoom
In a few words, describe your walk with the Lord
*
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