BIBLICAL CARE INTAKE FORM

Your name *

Email address *

ADDITIONAL INFORMATION

Phone number *

Address *

If married, how long have you been married?

Education - please list post high school

Are you part of Calvary SLO? If not, where do you consider your church home? *

REASON FOR SEEKING BIBLICAL CARE

What type of support are you looking for? *

Pastoral guidance

Prayer + encouragement

Marriage/pre-marital support

Help navigating grief, loss, or hardship

Guidance in a specific life decision

I’m not sure yet

Briefly describe what you’re hoping to receive help with. *

Have you met with a counselor or pastor before? *

If yes, who counseled you and was it helpful?

How would you describe what you’re going through? *

Mild Concern

Moderate Concern

Significant Concern

Urgent / would like to talk as soon as possible

Scheduling availability

• What days/times work best for you?

• Do you prefer meeting in person or over Zoom/phone?

Is there anything else you want us to know?

CONSENT TO BIBLICAL CARE GUIDELINES

Our Goal - We offer pastoral care to help you in a way that honors Jesus (Galatians 6:2).

Biblical Basis - Our guidance is rooted in Scripture. Our pastors and leaders are not licensed therapists; we serve as shepherds helping people follow Jesus (2 Timothy 3:16–17).

Confidentiality - We treat what you share with care and discretion (Proverbs 11:13). This form and any related notes will be kept on file for ministry purposes.

There are specific situations when limited information may need to be shared:

Seeking guidance from another pastor/elder (Proverbs 15:22)
Communicating with your home church’s leaders if helpful (Hebrews 13:17)
Concerns for someone’s safety (Proverbs 24:11–12)
Ongoing, unrepentant sin requiring church involvement (Matthew 18:15–20)
When a crime has been committed (Romans 13:1–4)

Please know that we aim to keep matters as private as possible.

I understand that this guidance is pastoral, not professional therapy, and that pastors and leaders are not licensed counselors. *

I understand that limited information may be shared only when necessary: *

I understand that what I share will be handled with care and discretion. *

I acknowledge these guidelines and give permission for pastoral follow-up. *

BIBLICAL CARE INTAKE FORM

ADDITIONAL INFORMATION

CHURCH INFORMATION

REASON FOR SEEKING BIBLICAL CARE

CONSENT TO BIBLICAL CARE GUIDELINES

Thanks for sharing. We’ll review your submission and a member of our team will follow up with you.