Counseling Intensive Inquiry Form

First and Last Name:
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Age:
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City/State:
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Phone Number:
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Email:
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How did you hear about A Soul Made Well?
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A Family Member
A Friend
Abuse Recovery Ministry Services
Called to Peace Ministries
Church/Pastor Referral
Counselor's Referral
Hope After Betrayal
Instagram Page
Living Waters of Hope
Online Search
Restored Nation
Other
Which best describe why you are seeking to do a counseling intensive (Check all that apply):
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In emotional crisis or overwhelmed by recent events
Seeking clarity on "stay or leave" decisions
Processing betrayal, domestic abuse, or trauma
Navigating spiritual confusion or struggling to trust God
Making immediate safety-based or legal decisions
Wanting to untangle confusion from truth
Beginning to rebuild voice, boundaries, and identity
Trying to identify healthy vs toxic relational patterns
Discerning godly sorrow from worldly sorrow
Wanting to explore what separate tracks of care and healing might look like for me and my spouse
Other
If you selected "Other" please expand on this here:
Please share a brief description of your current situation, beginning with the primary issue you are facing. Examples: betrayal trauma, covert control, divorce, domestic abuse, emotionally destructive relationship, family conflict, grief, post-abortion support, spiritual abuse by church leaders, etc.
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What days/times generally work best for you:
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I am flexible and will take any timeslot.
Monday Mornings
Monday Afternoons
Monday Evenings
Tuesday Mornings
Tuesday Afternoons
Tuesday Evenings
Friday Mornings
Friday Afternoons
Friday Evenings
Saturday Mornings
Saturday Afternoons
Saturday Evenings
What counseling intensive package is the right fit for you:
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Package 1: Two 2-hour phone sessions (4 hours total)
Package 2: Two 2-hour phone sessions (4 hours total) plus 1 follow up 60-minute session
Package 3: Two 2-hour phone sessions (4 hours total) plus 2 follow up 60-minute sessions
Other
If you selected "Other" use this space to explain. While I can't make guarantees, I'm open to discussing adjustments to the standard package if needed. For example, you might prefer two 3-hour sessions with two 1.5-hour follow up sessions.
Use this space to add additional comments/questions or provide any other information that might be helpful to know.
Please click on the checkbox to continue
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Thank you for your interest in doing a counseling intensive with A Soul Made Well Pastoral Counseling! Please fill out this form and I will be in touch shortly. Blessings!

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