Completed: 0%

Personal

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If not, what is?

Completed: 12%

Problem Description

Completed: 24%

Family
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Information About Children:

NameAgeGenderLivingYear Ed.Relationship

Completed: 36%

Health
What: Frequency:

Completed: 48%

Spiritual
   
* Permission to contact your pastor includes sharing information on this PDI.


Completed: 60%

Women Only

Completed: 72%

Problem Checklist

Please select areas you are struggling with.

Completed: 84%

Counseling Agreement

In this section would be special information regarding the counseling process, confidentiality, reasons for terminating counseling, etc.

Electronic Signature

I, , have carefully read the conditions for counseling set forth on this page and agree to enter into counseling in accordance with them.

I am filling out this form on behalf of the counselee:   

   

Completed: 100%

Complete

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Click "Finish" to submit your Personal Data Inventory.