Online Signup for Minors

Christian Counseling Online Signup for Minors (5-17)

Please fill out the form below in its entirety. This form is for parents/guardians of minors, aged 5-17, who wish to have their child treated at Trinity Christian Counseling. Once we receive your information, we will contact you to 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

For Your Safety
Face Masks Are
Required Indoors
Until Further Notice
Thank you from the Trinity team!