Christian Counseling Online Signup for Minors (11-17)

Please fill out the form below in it's entirety. This form is for parents / guardians of minors, aged 11-17, who wish to have their child treated at Trinity Christian Counseling. Once we receive your information, we will contact you to get finalize the acceptance of your child as a client. Your child is not yet a client until we confirm. Thank you for choosing Trinity Christian Counseling!





Please Fill Out the Following as it Relates to the Client


Family Mental Health History - Select Yes / No if Any Family Members Had the Below Issues & Please List Their Name / Relationship


CRISIS INFORMATION




MEDICAL INFORMATION



SPIRITUAL HISTORY


CHILD CHECKLIST OF CHARACTERISTICS