Counseling Application Form


Counseling Application

Mailing Address *
Confirm email address

Gender *
Marital Status *
Are you currently employed? *

how long have you been attending *
Which services do you attend regularly? *

Have you received previous counseling at Times Square Church or elsewhere? *
What type of counseling are you seeking? *
Is your spouse willing to come in? *
PLEASE BE ADVISED: As church counselors we are not professionals, licensed psychologists or psychiatrists. We simply offer Christian counseling based on the Word of God and an opportunity for prayer led by the Holy Spirit. Please be prompt for your appointments and make arrangements for childcare during your sessions as childcare is not provided.
PLEASE NOTE: We will attempt to get in touch with you three times. If after the third attempt we fail to get in touch with you, you must submit a new application for counseling.