Contact Information of Counselee

First Name

Last Name

Age

Gender

Male   Female  

Phone

Email

Marital Status  Married    Divorced    Widowed    Separated    Single   

 

Person Submitting Referral

First Name

Last Name

Phone

Email

What is your connection to the counselee?

How long have you known the counselee?

 

General Information

What is the presenting problem?

Do you know what has been done?

Why is Biblical Soul Care the right next step?

SOS

Use the SOS Chart below to assess the situation and risk. After completing each category, add the numbers together to get a total score. 

 

Thank you!

Thank you for taking the time to complete the forms. These will be extremely helpful to the Soul Care team in determining what is best for the counselee. Someone from the team will contact you soon for further information.

We would appreciate prayer for:

• Our team and others involved to have God's wisdom to accomplish all God is calling them to do.
• A soft heart for the counselee(s) and a renewed sense of God's presence in his/her life.
• A blend of truth and grace as counsel is given to the counselee(s).