The Basics of Biblical Counseling - Biblicalcounselingonline.org

PERSONALITY INFORMATION:
Have you ever used drugs for other than medical purposes? Yes No
What:_______________________________________________________________
When: ______________________________________________________________
Have you ever had a severe emotional upset? Yes No
Explain:_____________________________________________________________
____________________________________________________________________
Have you ever had any psychotherapyor counseling before? Yes No
If yes, list dates:_______________________________________________________
What was the outcome?_________________________________________________
____________________________________________________________________
Circle any of the following words that best describe you now:
active ambitious self-confident persistent nervous hardworking impatient
impulsive moody often blue excitable imaginative calm serious easy-going
shy good-natured introvert extrovert likable leader quiet hard-boiled
submissive self-conscious lonely sensitive other__________________________
Have you ever had hallucinations? Yes No
Do you have problems sleeping? Yes No
How many hours of sleep do you average eachnight?____
PASTORAL INFORMATION:
Pastor s Name:__________________________________ Phone: (___) ____ - _____
ChurchName:___________________________________ Phone: (___) ____ - _____
ChurchAddress:___________________________________________ Zip:________
Do you give permission to consult with your pastor as deemed helpful by counselor?
Yes No
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