If you would like to talk with a pastor, fill out the following information and we'll contact you. Personal Information Name * First Name Last Name * Male Female Email Address * Phone * (###) ### #### Any Previous Meetings? * Yes No If so, which pastor? Not Applicable Jim Gallagher Pete Vitale Kenny Pope Nate Gallagher Other Family Information Marital Status * Single Married Divorced Remarried Widow/Widower Names and ages of children Spiritual Information Do you believe that Jesus Christ is the Son of God and Savior? * Yes No How long have you been a believer? How often do you pray? * How often do you read your Bible? * Do you attend Calvary Chapel Vero Beach? * Yes No If so, what service? Sunday 8:00am Sunday 9:30am Sunday 11:15am Thursday 7:00pm Saturday 6:00pm Other If not, what church do you attend? Do you serve in any volunteer ministry? * Yes No Do you attend a weekly bible study or home Connect Group? * Yes No Briefly describe your reason for seeking biblical counseling * * I understand that Calvary Chapel Vero Beach offers biblical guidance; therefor I agree to submit to the authority of the Bible as the standard for the resolution for my issues. I understand that I am not seeking nor receiving professional paid counseling, but I am asking biblical, spiritual advice. I understand that confidentiality of this situation will be maintained; however, counselors may be required to discuss certain issues with the pastoral staff. I understand that Calvary Chapel Vero Beach reserves the right to inform the proper authorities in cases of imminent danger or child abuse. I have read and agree Thank you!
