Counseling Request - CityView Church

Phone number *

Who is the counseling for? *

Myself

Someone else

Type of counseling requested *

Individual

Marriage

Family

I'm not sure

Briefly describe why counseling is requested *

Gender *

Male or Female Counselor? *

Male

Female

No Preference

In Person or Virtual Sessions? *

In Person

Virtual

No Preference

Any other info you want us to know?

By checking the boxes below, you acknowledge the following: *

CityView has sole discretion on whether a counseling referral is made.

If a referral is made, CityView will pay for up to 3 counseling sessions.

CityView does not discuss the content of any session with a counselor.