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Application for Pastoral Counseling.

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Application for Pastoral Counseling.
Lindy's Letters of Love

Please print out and send completed form to Lighthouse in Scranton Inc. P.O. Box 199 Scranton, PA 18504

Application for Pastoral Counseling

  1. First and last name.

 

  1. Mailing address.

 

  1. Home and work phone number.

 

  1. Reason for desiring counseling.

 

  1. Medications: types and dosages.

 

  1. Past forms of therapy/counseling, and reasons for therapeutic or counseling visits in the past or at present.

 

  1. History or diagnosis of mental illness.

 

  1. History of addictions.

 

  1. If suffering from an addiction, list time in sobriety; weeks, months, years, days.

 

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