Welcome to Heavenly Counseling. We understand that taking this step can be difficult, and we want to acknowledge your courage in seeking support. This confidential form is designed to help us understand a little about your needs before our brief conversation. This ensures our 15-minute consultation is as helpful as possible for you.

Please know this initial call is a chance for us to connect, for you to ask questions, and for us to see if we are a good fit for each other. It is not a therapy session. Everything you share with Heavenly Counseling is held in the strictest confidence.

Section 1: Your Contact Information

First Name *

Last Name *

Phone *

Email *

Section 2: Understanding Your Needs

How recent was your loss?

Within the last 3 months

3 - 12 months ago

1 - 2 years ago

More than 2 years ago

What are you hoping to gain from this free 15-minute consultation?

I want to learn more about the Heavenly Counseling process.

I want to see if we are a good fit to work together.

I have a specific question about grief I'd like to ask.

I'm not sure, I just know I need to talk to someone.

Others

Is there anything specific you would like a space to briefly talk about?

Section 3: Logistics

How would you prefer to conduct the consultation?

Phone Call

How did you hear about Heavenly Counseling?

Search Engine (Google, Bing, etc.)
Social Media (Facebook, Instagram, etc.)
Referral from a friend or family member
Referral from a doctor or therapist
Online Article or Blog
Other
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Section 4: Consent & Submission

Acknowledgement

I understand that this free 15-minute consultation is an introductory call to learn more and is not a therapy or emergency crisis session.

I have read and agree to the Heavenly Counseling