Biblical Guidance Intake Form

Today's Date*

Personal Information

Name*

First Last

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary contact number*

Birth date*

Spouse name (if joint biblical guidance requested)

Gender at birth*

Male
Female

Marital status*

Campus*

Vocation*

Current living situation *

Personal Experience with Jesus

What is your religious affiliation? (Baptist, Catholic, etc.)*

Victory Involvement

Have you taken membership class?*

How long have you been a member?*

Which church do you attend?*

Have you sought their input on the matter?*

What advice was given?*

Are you a leader?*

Are you in a small group?*

What’s your Leader’s name?*

Do you currently support Victory with your tithes and offerings?*

Have you taken, or are you participating in, any of the following financial classes?*

Crown Financial
Financial Peace University
Growing a Business
Compass
Financial Hope Workshop
No

Have you taken, or are you participating in, any of the following Family Life classes?*

Married Life
PreMarried Life
No

Have you taken, or are you participating in, any of the following Spiritual Growth classes/initiatives?*

Forward
New Believers
Next Steps
No

Other

Counseling

In what area are you seeking biblical guidance?*

Have you seen a Victory Care Minister?*

Would you like to see one?*

With whom and when?*

Have you had any previous or present professional counseling?*

What type?*

Are you currently in the care of a doctor?*

Do you take any medications?*

Please list medications:*

Have you ever been in a mental or psychiatric facility?*

What issue(s) do you want to work through in this session?*

Emotional
Family (General)
Financial
Marital
Parenting
Sexual

What do you wish to gain from this biblical guidance session?*

Why are you requesting biblical guidance?*

Biblical Guidance

Personal Information

Personal Experience with Jesus

Victory Involvement

Counseling

Victory Church