Request

Please complete the form below to request counseling services from Harvest Bible Chapel Pittsburgh North.

Counseling services typically run 7-9 weeks only, no longer. God has provided a permanent counselor with Jesus Christ (Isaiah 9:6, Proverbs 15:22).

IMPORTANT!
In order to receive counseling services you must actively participate in weekly Sunday church services as well as be plugged into a weekly Small Group, diving into God's Word. Homework will be provided and expected to be completed prior to each week's session.

Note:
Marriage or individual male counseling will meet directly with Pastor Jeff. If an individual woman seeks counseling, another woman in the Lord will be made available to counsel you.

Requestor Information:

First Name

Last Name

Requestor Phone

Requestor Email

Requestor Address

Purpose of Counseling Request:

What type of counseling are you seeking help for?

Individual Marriage

Request Description

Previous Counseling

No Yes

Previous Counseling Explanation

General Information:

HBC Relationship

No Yes

Are you a believer and follower of Jesus Christ?

No Yes

Do you regularly attend Sunday church services?

No Yes

Do you currently attend a weekly Small Group?

No Yes

Signature:

By submitting and signing this form (selecting "Yes" in the signature section) you hereby are guaranteeing that all of the information provided to Harvest Bible Chapel Pittsburgh North is accurate and truthful to the best of your ability.

Recipient's Signature

Accept Decline

Please review your selections above to ensure that the approver(s) have all of the necessary details to determine the requirements for your counseling request.
IMPORTANT! You will receive a confirmation email of the request submission for your records.

We look forward to working with you during your time of need, YOU ARE LOVED!

Submit Request