Christian Anxiety Counseling Intake Questionnaire
Personal Information
Full Name
Date of Birth
Phone Number
Email
Address
Spiritual Background
Home Church (if any)
Briefly describe your faith journey
How comfortable are you with prayer or discussing scripture during sessions?
Comfortable
Somewhat Comfortable
Not Comfortable
Presenting Concerns
Describe your current experience with anxiety
How has anxiety affected your daily life?
How long have you been experiencing these concerns?
Have you attended counseling before? If yes, please explain.
Support System
Who do you turn to for support?
Family situation
Goals & Expectations
What are your goals for counseling?
What do you hope to gain from Christian counseling?