Couples Counseling

Please fill out the form below as detailed as possible so that we can get you lined up with the most appropriate avenue of healing.

Name

First Name

Last Name

Phone

(###)

###

####

Age

Name of significant other

First Name

Last Name

Age of significant other

Are you a member of Center Point Church?

Yes

If not, how often do you attend?

Have you previously met/spoken with a leader from Center Point about your situation?

Yes

Status of relationship

Length of relationship

Reason for seeking help

Relationship strengths

Relationship risks and concerns

Counseling goals