Please enable JavaScript in your browser to complete this form.Name *FirstLastPhone Number *Email *Where are you located? (City, State)What church do you belong to? (Name, City, State) *Please include the city in your response. Days available for counseling *SundayMondayTusedayWednesdayThursdayFridaySaturdayTimes available for counseling *MorningAfternoonEarly EveningsEveningsSchedule constantly changesReason for Counseling *Provide a brief description of why you are seeking counseling. Any other information we should know?Do you have a preferred Counselors?James Schroeder, MABrad Burkett, MAJeremy HoughtonJeremy Gengler, MABCNo PreferenceNameSubmit
