Crossroads Ministries - Woodstock GA - Georgia - Children Counseling Counselors



 
770-926-7724
102 Springfield Drive, Suite 205
Woodstock, GA.
 


CROSSROADS CHRISTIANS MINISTRIES
INFORMATION SHEET

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Date of Birth 

 		  
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Age

 		  
Both Parent's Name
 
 

 		  
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Spouse's Name

 		  
Boy/Girl Friend

 		  
Children or Siblings  
   
Name
Age
 
 
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Age

 		  
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Age

 		  
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Name
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Address

 		  
City

 		  
Zip Code

 		  
Home Phone

 		  
Work Phone

 		  
Cell Phone

 		  
Email
 
 
Referred by
 
 
List of prescription medications
 
 
 
 
 
 
 
Comments
 
 
 
 

Crossroads Christian Ministries is non-profit, non-denominational, Christ-centered counseling ministry. Jeff Jordan is an ordained minister.

Part of our time together may be spent in looking at past and present hurts and in uncovering old patterns of coping which have proven destructive to yourself and others. Homework may be given to help the process along.

Since Crossroads is a ministry, we are totally dependent upon contributions to meet operating expenses. Counselees are encouraged to make contributions to help support this work at a rate of $40 a session. This should not be understood as a charge. Since Crossroads depends upon such moneys to meet its operational expenses, we would ask that you prayerfully consider your opportunity and responsibility in this matter.

The policy regarding young people, 16 years old and under is that at least one parent be willing to be a part of the counseling process, and be willing to do some reading assignments.

In the event that you must reschedule you appointment, we ask you to please notify the office 24 hours in advance, or make a contribution for half the session missed.

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Because of building management children cannot be left unattended in waiting room or hallways. Please do not allow children to bang on floor.