Counselor Survey

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Counselor Survey

Believers Fellowship Church

Name of Counselor, Psychiatrist, or Psychologist *

Reason for Counseling (select all that apply) *

Marriage Issues

Infidelity

Anxiety

Depression

Pornography

Alcohol Addiction

Drug Addiction

Suicidal Thoughts or Attempts

Cutting

Anorexia, Bulimia

Sexual Abuse

Physical Abuse

Same-Sex Attraction

Gender Identity

Parenting

Family of Origin Issues

Trauma

Grief / Loss

Stress Management

Other:

Required

If your counseling was for marriage issues, did the counseling result in...

A stronger marriage

Status quo (little change)

Divorce

N/A

Clear selection

Would you recommend this counselor? *

Yes, wholeheartedly. The counseling resulted in significant positive life change.

Yes, with some reservations.

Probably not.

Definitely not.

Did this counselor approach counseling from a biblical perspective? *

Yes

Unsure

Please provide any other information that could help us determine whether or not we should recommend this counselor to others. What sort of problems is he or she good at addressing? What sorts of people would most benefit from his or her particular approach?

Name (Optional)

Age at Time of Counseling

Gender

Female

Male

Clear selection

Contact Info (Optional)

Submit

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