Counseling Intake Form

Please fill out this counseling intake form and select the day/time preferable for you to meet with Pastor Jeske. Once you've completed the form, Pastor Jeske will confirm a date and time for your appointment.
Assessment #1 - Identifying Idols

Uncover your potential “idols” by taking this assessment. After reading the definition, consider each one of the things listed below in light of the “it might be an idol if…” examples and according to your gut, not your head answer by checking either yes, no, or possibly.


Definition: An idol can be any thing or person (even good things) that we might value more highly than we should and it becomes more important than God.

It might be an idol…

• if your thoughts and time are consumed by it.

• if you are willing to do anything to get it even at the expense of others.

• if you believe it will give you things that only God can give (peace, joy, etc.).

• if you believe having it will give your life purpose, meaning and value.

• if you were to lose it you would despair.
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Assessment #2 - Identifying Beliefs

Uncover your operating beliefs by taking this inventory. According to your gut, not your head, read each statement and then check the box that best describes you: strongly believe, sometimes believe, never believe.
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Assessment #3 - Spiritual Check-In

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Name and Contact Information

 
 
 

Description

Please fill out this counseling intake form and select the day/time preferable for you to meet with Pastor Jeske. Once you've completed the form, Pastor Jeske will confirm a date and time for your appointment.