Counseling Consult Form

For People Seeking Counseling Services

Step 1: Request a Counseling Appointment

Individual Consult Form:

Describe your request for service.* (briefly tell us what you need help with: for example: anxiety, depression, hopelessness, relationship problems, fearfulness, etc.) If you have an emergency, please contact 911 in the USA or your local emergency telephone number if you are in another country. We generally respond to emails within 1-2 days.

Name*

First

Last

Phone*

Email*

Address*

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

Word Verification

Filling out this form & hitting submit verifies: Acceptance of Disclaimer/Waiver for this & ALL future ENM activities/materials. All Encouragement Now Ministries (“ENM”) classes, videos, written manuals, notes, slides, & all other information or materials (collectively, “ENM Information”) provided by ENM, its employees, agents, volunteers, & guests (“ENM Parties”) is for informational use only & is not intended as a substitute for professional counseling, advice, or care (including, without limitation, medical, psychological, financial counseling, advice, or care). Note: all clinical opinion letter requests are to be made at a client's request with the understanding that they will come at an extra fixed fee determined by ENM. Discussions with ENM Parties may be considered for discussion & personal choice options/opinions only. All personal information provided by the party signing above, on his/her own behalf, or on behalf of a minor/ward (“Attendee”), may be considered confidential if provided in a private, one-on-one setting. Discussions in a group setting are voluntary & negate any confidentiality. All ENM Information does NOT necessarily reflect the views or opinions of ENM or their staff. All ENM Information is provided to Attendees solely for the purpose of examination & at the Attendees’ own risk. ENM Parties are NOT responsible for errors or misconstruing of intended knowledge/advice in any ENM Information (e.g. An ENM staff member/counselor would never advise a client to stop using a medication without consulting a Doctor or Psychiatrist) ATTENDEE HEREBY AGREES TO INDEMNIFY, DEFEND, & HOLD HARMLESS ENM PARTIES, THEIR AFFILIATES, SUCCESSORS, OFFICERS, COUNSELORS, TEACHERS, & ASSIGNS OF ANY LIABILITY WHATSOEVER IN CONNECTION WITH THE PROVISION/USAGE OF ANY ENM INFORMATION, INCLUDING: INJURY, DAMAGE, FINANCIAL LOSS (DONATIONS GIVEN TO ENM AS A NON-PROFIT ORGANIZATION ARE NOT REFUNDABLE) OR ANY OTHER DAMAGES WHATSOEVER. Attendee understands that he/she voluntarily attended any classes/sessions with/from ENM & accepted any ENM Information freely. Attendee also accepts his/her own responsibility to use all ENM Information, provided free of charge, wisely, & at his/her sole discretion/risk. As all services are provided free of charge, ENM reserves the right to refuse service. Note, service is typically provided on a first-come-first-serve basis, we cannot guarantee that a counselor will be readily available. *

I understand & accept this disclaimer.*

Step 2: Scheduling a Session

Upon receiving your Consult Form (above), we will contact you on how to set up an appointment. Thank you for cooperating with our client procedures.

If you already have the appointment log in:

Click here to SCHEDULE

What our Members are saying:
Encouragement Now Counseling has changed my life in more ways than I can count. I needed counseling during one of the lowest points in my life and I found a counselor who listened to me, cared about what I was going through, and genuinely wanted to help, and for that, I will be forever grateful.

Bianca – Client of Encouragement Now Ministries

Other Testimonials