Personal Data Inventory Form - Greenwood Header Image

Personal Data Inventory Form

What is your affiliation with College Park Church Greenwood?*

How do I know if I'm a member of College Park Greenwood?

A member of College Park Greenwood is someone who has attended a membership class, signed the church covenant, and has been voted in by the congregation. Learn More about Membership at College Park Greenwood

A regular attender is someone who attends College Park Greenwood regularly, has filled out a Connect Card and/or is giving financially to the church by check, credit card, or online giving.

Where do you attend church?*
How did you hear about the Counseling ministry at College Park Church Greenwood?*
Are you asking for individual counseling or couples counseling?*

If you are requesting couples counseling we ask that each spouse fills out their own Personal Data Inventory (PDI). Once both forms are completed and submitted you will both be contacted for an intake interview.

Personal Information

Name*
Address*
Birthday*
Gender*
Do you have children?*
Do you work in the Healthcare field or as a caregiver of someone in the Healthcare field?*

Marriage

Spouse*
Birthday *
Date of Marrige*
Is your spouse willing to come for counseling?*
Are you currently being abused in this marriage?*
By abuse we mean physical violence, verbal threats, manipulation through guilt, name-calling/put-downs, using Scripture to coerce, using fear to intimidate, isolating from others and other abusive actions.

Children

Child Name
Birthdate
Stepchild?
Child Name
Birthdate
Stepchild?
Child Name
Birthdate
Stepchild?
Child Name
Birthdate
Stepchild?
Child Name
Birthdate
Stepchild?

Health

Rate your current health*
Are you willing to sign a release of information form so that your counselor may request social, psychiatric, or other medical records?*

Spiritual

Do you believe in God?*
Would you say you are a Christian?*
How often do you attend per month on average?
How often do you pray?*
How often do you read the Bible?*
Have you ever been baptized?*

Presenting Problems

What problems are you currently facing? Check all that apply.*

Information on this form is viewed as private and will not be shared outside College Park Church Greenwood unless you authorize consent. If you have any questions regarding this form or College Park Church's counseling policy, please contact soulcare@yourchurch.com

Availability for Counseling

For weekly counseling please indicate the times you would be available below. The more flexible you are in your availability, the more quickly you can be placed with a counselor. Before weekly counseling is established we will conduct an intake interview. This will most likely be done on a weekday and take approximately one hour to complete.  If you need immediate spiritual care, please call the church office at (317) 535-5774. 

Check all that apply for Weekly Counseling*

Consent to Counsel

Please read and review the Consent to Counsel Form.

I have reviewed the Consent to Counsel form and agree to its guidelines.*

Please read and review the Facts About Biblical Counseling 

I have reviewed the Facts About Biblical Counseling and agree to its guidelines.*

Having clarified the principles and policies of our counseling ministry, we welcome the opportunity to minister to you in the name of Christ, to be used by him as he helps you to grow in spiritual maturity and prepares you for usefulness in his body.

If you have any questions about these guidelines, please contact greenwoodsoulcare@yourchurch.com. 

If the guidelines of the consent form are acceptable to you, and you affirm that all the information in this form is correct to the best of your knowledge please sign below.

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