Counseling Intake

If you are experiencing a life threatening or mental emergency CALL 911

If you are a victim Domestic Violence contact the National Hotline at 800.799.SAFE (7233) or Call local authorities or 211 for resources.

Thank You for choosing B4C Ministries for your counseling needs. Below are details regarding our business practices and services. Please read it thoroughly and reach out to us if you have any questions. At the signing of this document, you are entering into an agreement with B4C Ministries.

B4C is a Christian based organization using the bible as our main resource for tools to help you grow. Our desire is for you to walk in a closer relationship with God through Jesus, to be free from the torment of your past, and to be who God has made you to be. We counsel through Christian Counseling courses and are not state licensed therapists.

CONFIDENTIALTIY

Sessions are a safe, professional, Christ centered, respectful spaces focused on trust and open communication. The information you share with your counselor(s) is confidential: accept for reasons of legal obligation, a medical emergency or expected harm to you or by you, your information will NOT be disclosed to any one. If you wish for an individual to access your records, you must submit your requesting in writing with a liquid signature.

Your emergency contact will be reached in the event of a medical or psychiatric emergency, without disclosure of details concerning your counseling sessions.

SESSIONS:

Online - Available to sign in 5 minutes prior to start time

Counseling Session Length = 45 minutes

PAYMENT:

Acceptable Payments = Credit/Debit - We DO NOT accept insurance

Payments must be made in advance for services. Cost varies according to booked sessions.

REFUNDS:

We do not offer refunds.

APPOINTMENTS/ CANCELLATIONS:

Initial appointments are scheduled online, however, future appointments can be made by contacting our Admin staff via Text/Call 512-887-3583 or email B4Cprod@gmail.com Mon - Sat 8 am - 6 pm CST.

Please text or email us to cancel or reschedule your session at least 24 hours in advance for the payment to be applied to your next session. If you do not reschedule or cancel 24 hours in advance, your payment will apply to the missed session, and you must pay again for your next session.

Your therapist reserves the right to cancel your appointment if any issue may interfere with the counseling session:

CLIENT SESSION RESPONSIBILITIES:

Over the age of 18

Financially Responsible for cost

Provide a private, safe, confidential, distraction free location with minimal noise.

Access and function Zoom software

Full participation

Please request resources you may need

LIABILITY RELEASE:

Counseling may bring to the surface deep feelings that may evoke strong emotional responses. Your commitment throught this process will help you persevere through those hard moments. If you do not wish to have biblical services, please reach out to another agency that is able to accommodate your need.

UPDATE CONTACT INFORMATION:

Please update our office in writing with updated contact information

If you have any questions or concerns, please contact us 512-887-3583 or B4Cprod@gmail.com

Client First Name

Client Last Name

Address

Date of Birth required

Current Phone

EMERGENCY CONTACT

First Name

Last Name

Relationship to You

Current Phone

LIABILITY RELEASE:

By signing below, I agree to obtain Biblical Christ-Centered counseling services provided by B4C Ministries, I agree to have read and understood the previous rules of conduct, accept financial responsibility for services and release from liability Bold 4 Christ (B4C) Ministries, affiliates, staff and its counselors, from any and all claims or litigation arising from participation in the counseling program. I understand:

That all sessions will be provided by B4C counselors and not licensed therapists with national psychological or psychiatric association.
We do not prescribe any medications or give medical advice, but may advise you to contact medical help
Services provided in this ministry are both biblically based and relevant

Payment for services is due at the time of submission.

We look forward to working with you.

Select Your Payment Plan

Weekly Sessions = 4 Weeks @ $72 per week - $288.00

Bi Weekly = 2 Weeks per month @ $95 per week - $190.00

Monthly Session = 1 per month @ $150 mo - $150.00

Preapproved Arrangement - $0

Payment SENT via Cash App - $0

Your Signature

Thank you. Our staff will contact you for payment and review.