Biblical Encouragement Form

Please complete and submit this form. We must receive it at least 48 hours before your appointment 

Name *
Name
Date of Birth *
Date of Birth
Address *
Address
Cell Phone *
Cell Phone
Spouse's Name
Spouse's Name
Spouse's Address
Spouse's Address
Spouse's Cell Phone
Spouse's Cell Phone
List names, ages, sex, natural or step child.
Are you committed to follow through with the ministry and instruction you receive? *
Please describe your spiritual walk journey.
Are you a member of The Crossing Church *
I currently do or have in the past struggled with the following? *
I currently do or have in the past struggled with the following?
For a Current Struggle select Strongly Agree For a Past Struggle select Agree If it is not a Struggle select Strongly Disagree
Worry
Suicide
Rejection
Unforgiveness
Anger
Guilt/Shame
Low Self Esteem
Night Terrors
Insecurity
Compulsive Thoughts
Obsessive Thoughts
Lustful Thoughts
Doubt
Depression
Anxiety
Fear
Spiritual Abuse
Physical Abuse
Sexual Abuse
Verbal Abuse
Emotional Abuse
Chemical Addiction
Alcohal Addiction
Sexual Addiction
Gambling Addiction
Please answer and type your name as your signature.