Counseling Request

The person requesting counseling should fill out this form with their information

Your name *

Email address *

Phone number *

Marital status *

Gender *

Birthdate *

Household members

Preference for Counseling *

Please choose the option that best fits your need.

Pastoral Counseling: Counseling by an OFA pastoral staff member.

Professional Counseling: OFA referral of Christian-based counseling by a degreed counselor.

Description of counseling needs. *

Have you previously received counseling services? *

Yes

If yes, please share when and where. *

Do you have insurance that would help cover the cost of professional counseling? *

Please note that not having insurance will not prevent you from obtaining professional counseling services.

Yes

Other

Do you currently attend Owasso First Assembly? *

Yes

If you do not attend Owasso First Assembly, do you have a church home? *

Please note that Owasso First Assembly will not be able to financially assist non-OFA attendees seeking professional counseling. OFA may be able to assist you with pastoral counseling or help you get in touch with a professional counselor. *

Please Initial that you understand and agree.

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