Request for Biblical Counseling

Personal Information



Briefly answer the following questions:

















Consent to Biblical Discipleship Counseling for Those Under 18 Years of Age

CONSENT TO BIBLICAL DISCIPLESHIP COUNSELING AND RELEASE OF LIABILITY:

What is Expected of you?

It is our belief that change must begin with ourselves as we look to Jesus Christ for the power to change. Therefore, we ask you (counselee) to approach the counseling and encouragement process as an opportunity for personal change and spiritual growth. We ask that you refrain from the temptation of focusing on others, and instead we ask you to focus on what changes God desires to make in your life during your circumstances. Be advised that you will be assigned “homework”. Homework is a vital part of the change process; therefore, completion of the homework assignments before your next sessions is expected.

Confidentiality Clause

1) Absolute confidentiality is not scriptural. In certain circumstances the Bible requires that facts be disclosed to select others (Mathew 18:15ff). In these areas we follow guidelines of Sun River Church. When your church leadership inquires, we will disclose to them the information they need to effectively and biblically fulfill their responsibility to shepherd you.
2) The privacy and confidentiality of our conversations and records are a privilege of yours and are protected by our ethical principles in all but a few circumstances. BY LAW, there are certain situations in which information about individuals undergoing counseling may be released with or without permission. These situations are as follows (Romans 13:1-3):
A. Where it is proven that children are physically abused, neglected, or sexually abused.
B. In emergency situations where it is proven that there may be danger to the counselee or others, as with homicide or suicide, confidentiality may be broken.
C. If a court of law issues a legitimate subpoena relating to a child abuse case, we are required by law to provide the information specifically described in the subpoena.
D. If an unreported life-threatening felony has been committed, we are required by law to report it to police.
3) We reserve the right to consult with others or appropriate church ministry staff members regarding sessions. This consultation will be held in the same level of confidence as your sessions. This will involve issues such as:
A. Church discipline matters.
B. Seeking wise counsel to help address the matter in a thorough manner.
C. Reporting to other leaders on the status of counseling when feasible and appropriate.
D. Training of other counselors to learn how to handle cases of the same nature.

Resolution of Disagreements

If a dispute should arise between the counselee and the counselor regarding the session or the counselor’s advice or conduct, one should bring this dispute to the attention of the director of the Biblical Discipleship Counseling ministry of Sun River Church. If the dispute cannot be resolved at this level, all parties agree to resolve such dispute by submitting to the Conflict Resolution Team of Sun River Church for full and final resolution and conciliation. Both, the counselee, and the counselor agree not to take this matter to any secular court system (1 Corinthians 6:1-7).

Waiver of Liability

The undersigned counselee, having sought biblical discipleship counseling as adhered to by Sun River Church, a nonprofit religious organization, hereby acknowledges their understanding of the above stated conditions and therefore releases from liability Sun River Church and any/all participating churches, pastors, agents, or employees, from a claim or litigation whatsoever arising from the undersigned’s participation in the above-mentioned biblical discipleship counseling ministry. It is further understood, in consideration for receiving any form of counseling from Sun River Church, the person (counselee) receiving the counseling agrees to release and waive all claims of any kind against the ministry, the staff, the pastoral/lay counselors, the elders or any participating church, which may arise from, result out of, or be related to conduct or advice/counsel given. Additionally, all counsel provided by Sun River Church is provided in accordance with the biblical principles adhered to by the church and is not necessarily provided in adherence with any local or nation psychological or psychiatric association.

The undersigned agrees that he/she has read and thoroughly understands and agrees to what is expected of them in the confidentiality clause, the resolution of disagreements, Sun River Church’s Policy for counseling that is placed on the website, and the contents of this waiver, and now willingly (without any coercion) consents to and requests said biblical discipleship counseling from Sun River Church’s biblical discipleship counseling ministry.



By checking this box, you confirm you have read and agree to the terms of counseling and confirm you are a parent or legal guardian for the counselee under 18.


By checking this box, you confirm you have read and agree to the terms of counseling. You will also receive this Consent Form in an email. You are required to print and sign this agreement and bring it to your first counseling session.