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Problem Description

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Information About Children:


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* Permission to contact your pastor includes sharing information on this PDI.

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Women Only

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Problem Checklist

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Counseling Agreement

Consent to Biblical Counseling

Welcome - We at LBCM look forward to helping you with your problems using Gods Word. In order to be as clear as possible about the counseling and the administrative procedures used at LBCM, please read the following information. Indicate your agreement to it by putting your signature and the date at the bottom of this form. This signed form must accompany your personal information forms before we can schedule an appointment with you.

Our Goal - Our goal in providing biblical counseling is to help you meet the challenges of life in a way that will please and honor the Lord Jesus Christ and allow you to enjoy fully His love for you and His plans for your life.

Biblical Basis - We believe that the Bible provides thorough guidance and instruction for faith and life. (2 Peter 1:3 and Romans 15:4) Therefore, our counseling is based solely on biblical principles rather than those of secular psychology or psychiatry.

Advice Provided - If you have significant legal, financial, medical or other technical questions, you should seek advice from independent professionals not associated with LBCM. Our pastoral and lay counselors will be happy to cooperate with such advisors and help you to consider their counsel in the light of relevant biblical principles. By signing this Consent to Biblical Counseling you agree to hold LBCM and Lakeside Bible Church harmless in any and all matters associated with the biblical advice you have received.

Fees for Counseling - The biblical counselors at LBCM provide their time, energy and spiritual gifts as a service to God and as a labor of love to those who are seeking help with problems in their lives (1 Thessalonians 2:7-8, 1 Timothy 1:5). LBCM does not charge for counseling services.

Homework - The biblical counselors at LBCM will assign you homework to take home between your weekly counseling sessions. The assignments are meant to provide accountability and encourage lasting change.

Time - Habits are not developed overnight, and new habits will take time to develop. In most cases, we ask individuals to commit to regular counseling appointments for a period of 3 to 4 months.

Missing sessions - Counselees are asked to cancel appointments at least 24 hours prior to the appointment. This gives others the opportunity to use the cancelled time slot. If no cancellation is made, or less than 24 hours notice is received you will risk your counseling case being inactivated and your time slot will be given to the next case on our waiting list.

Confidentiality - Confidentiality is an important aspect of the counseling process, and we will carefully guard the information you entrust to us. However, because we are continually training others to be effective counselors we ask that you agree to allow counselors in training to be present during your sessions. There are five other situations when it may be necessary for us to share certain information with others: (1) When a counselor is uncertain of how to address a particular problem and needs to seek advice from another counselor, ministry leader or elder/pastor in our church; (2) when a counselee attends another church and it is necessary to talk with his or her pastor or elders; (3) when there is a clear indication that someone may be harmed unless we otherwise intervene; or (4) when a person persistently refuses to renounce a particular sin and it becomes necessary to seek the assistance of others in the church to encourage repentance and reconciliation (see Proverbs 15:22; 24:11; Matthew 18:15-20); or (5) when there is illegal activity and we are required by law to speak to the authorities. Please be assured that our counselors strongly prefer not to disclose personal information to others, and they will make every effort to help you find ways to resolve a problem as privately as possible.

Resolution of Conflicts - On rare occasions a conflict may arise between a counselor and counselee. In order to make sure that any such conflicts will be resolved in a biblically faithful manner, we require all of our counselees to agree that any dispute that arises with the counselor or with our church as a result of counseling will be settled with mediation within the church according to the principles of scripture and the authority of our local church, and, if necessary, legally binding arbitration in accordance with the Rules of Procedure of the Institute for Christian Conciliation; judgment upon arbitration award may be entered in any court having jurisdiction.

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Having clarified the principles and policies of our counseling ministry, we welcome the opportunity to minister to you in the name of Christ and to be used by Him as He helps you to grow in spiritual maturity and prepares you for usefulness in His body. If you have any questions about these guidelines, please talk with your counselor. If these guidelines are acceptable to you, please sign below.

Electronic Signature

I, , have carefully read the conditions for counseling set forth on this page and agree to enter into counseling in accordance with them.

I am filling out this form on behalf of the counselee:   


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Thank you for taking the time to fill out this form! Your complete and honest answers will aid the counseling process and allow the counselor to better understand you and your situation. We encourage you to review your answers. Once you click "Finish" an email will be sent to Lakeside Biblical Counseling Ministry. Please make sure your email address is filled in under the Personal section so you receive a copy of your PDI form.

If you have any questions about these guidelines, please contact Lakeside Bible Church at (936) 582-1977

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