Counseling Request Intake Questionnaire
If you are interested in pastoral counseling at Lighthouse, please complete the following form.
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    Please share the best phone number to contact you/leave a message.
  • Regular basis = at least once a month.
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  • Thank you for taking the time to provide answers to these questions. A pastor will be contacting you as soon as possible.

    PLEASE NOTE: if you get a blank screen after submitting your form, please scroll up to the top of the page. You will be prompted to complete missing fields before resubmitting your form.