Counseling Agreement Form
The following outlines several conditions upon which counseling cases will be initiated. While
this is not meant to be exhaustive in scope, it does represent our philosophy of biblical
counseling, a vital aspect of the shepherding ministry of Christ Covenant Church.
Our Goal
Our goal in providing biblical counseling is to help you meet the challenges of life in a way that
will please and honor the Lord Jesus Christ and allow you to enjoy His love and His plans for
your life. We’re glad that you’re taking this important step to seek godly counsel. No matter what
your situation, this is a time in your life that the God of all creation knows and understands
completely and therefore, there is great hope! This form allows us to communicate some of our
perspectives and convictions which we believe honors God and will help you.
Biblical Basis
We believe that the Bible provides thorough guidance and instruction for faith and life. (2 Peter
1:3; Romans 15:4) Therefore, our counseling is based solely on scriptural principles rather than
those of professional Psychology or Psychiatry.
Not Professional Advice
I understand and agree that Christ Covenant will only be providing spiritual guidance and
biblical support and cannot provide mental health, clinical, or diagnostic Psychotherapy. If you
have significant legal, financial, medical or other technical questions, you should seek advice
from independent professionals not associated with Christ Covenant Church.
By signing this “Consent to Biblical Counseling” agreement, I do hereby waive, release, and
discharge Christ Covenant Church from any liability and all injuries, whether emotional or
physical, which I may sustain while enrolled in Christ Covenant Church counseling. I do state
my intention to waive any such claims and never assert any claim of any motive against Christ
Covenant Church or the Counseling ministry of Christ Covenant Church.
Confidentiality
Confidentiality is an important aspect of the counseling process, and we will carefully guard and
protect the information you entrust to us. For your own safety and for the protection of other
individuals whether directly or indirectly, there are some certain exceptions to this policy when it
may become necessary for the counselor to share particular information with others:
- If during the course of counseling, the counselor and or the leadership of Christ Covenant
Church determines that a threat of physical harm to the counselee or to another person is
imminent (including Child, Sexual, or Elderly abuse), the appropriate individuals and authorities
will be notified, by law, in accordance with following Florida Statutes: FS 39.201; FS 39.202; FS
39.204; FS 490.0147; FS 491.0147. - When a counselor is uncertain of how to proceed or address a particular problem and needs to
seek counsel and guidance from the Senior Pastor and or Elders of Christ Covenant Church. - Criminal incidents which are revealed or come to be known during the course of the
counseling relationship that endanger the counselee, family members, church members, or other
individuals.
Resolution of Conflicts
On rare occasions where a conflict may arise between counselor and counselee:
In order to make sure that any such conflicts will be resolved in a biblically faithful manner, we
require all of our counselees to agree that any dispute that arises with the counselor or with
Christ Covenant Church as a result of counseling, will be settled with mediation within the
church according to the principles of scripture and the authority/leadership body of this local
church.
Termination of Counseling
At any time during the counseling process, for reason(s) sufficient to him/her, the counselee, or
the counselor, shall have the option of terminating the counseling relationship.
Fees
This is a grace ministry of Christ Covenant Church and as such, there are no fees associated for
members of this Church.
Having clarified the principles and policies of our counseling ministry, we welcome the
opportunity to come alongside you in the name of Christ to bring help and hope, and to seek
God’s transformational work in your life.
If you have any questions about these guidelines, please speak with one of the elders. If these
guidelines are acceptable to you, please sign below.