Couples Welcome & Intake | Wayview Christian Counseling

Couples Welcome Form

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Name *

First

Last

Email *

Phone Number *

Marital Status *

How long have you been together? *

Has there been infidelity in the relationship? *

What do you see as the main challenge or challenges in your relationship? *

Tell me about your faith journey or church background? *

Is there anything else you'd like me to know before our session? *

Agreement *

I agree with the above terms

Care provided by Wayview Counseling is pastoral in nature and is offered within the clergy provision of Florida Statute §490.014(2)(f) and the Christian Clinical Counselor subsection of Statute §491.014(3). Professional referrals available upon request.
If you are experiencing a mental health crisis please call 988 or 911.

IT'S TIME TO HEAL

Phone (813) 296-5795

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REV. STEPHEN PASQUALE, BCPC

Spring Hill, FL • Wesley Chapel, FL • Tampa, FL

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