Appointments - Living Waters Counseling

Please complete the form below to request more information, schedule an appointment, or request prayer. You can feel secure in knowing that your information will be held in strict confidence and will never be sold or given to anyone besides our staff.

Name(Required)

First Last

Date of Birth(Required)

Age(Required)

Address(Required)

Street Address City State ZIP Code

Cell Phone(Required)

Home Phone

Allow voicemails?(Required)

Yes

Email(Required)

A brief summary of client issues:(Required)

I am requesting more information about Living Waters Counseling :

Please mail the information to me

I have some questions. Please call me

I would like to schedule an appointment with a counselor :

Please call me to schedule an appointment

Please email me to schedule an appointment

If you desire an appointment, please briefly describe the subject matter you would like to discuss. This information will help us get you connected with the best counselor for your situation. :

We believe that God hears and answers pray. There is nothing too small or too large that he does not care about it. If you would like us to pray with you about something that is on your heart, then please tell us below and it will be our honor to pray with you. :

If you are having suicidal thoughts, please contact 911 or go directely to the ER. We can help you after you receive the help you need for this immediate issue. Please do not let these thoughts go unattended.

Yes, I acknowledge

Not Applicable

Comments

This field is for validation purposes and should be left unchanged.