Christian Talk Therapy

Sophia Avery, MA -Christian Therapist

 

"The Lord God hath given me the tongue of the learned, that I should know how to speak a word in season to him that is weary."          Isaiah 50:4

2449 Golf Road
Suite 3
Philadelphia, PA 19131

ph: 215-931-3070

Initial Intake Form

Prior to your Initial Consultation, we ask you to provide some basic information to help us get an idea of you and your situation.

Please Read our Counseling Disclosure Statement and complete the form to the right.  We look forward to working with you!

Please Read our

Counseling Disclosure Statement

Before engaging in therapy, we require that you read and accept our Counseling Disclosure Statement.

 Click Here to review the form and once you have read it, please type "Yes" at the first area on the right. If you have questions, please send an e-mail from the "Contact Us" page.

 

 

Suicide/Homicide Alert

If you are having thoughts of hurting yourself or someone else, for your safety, we advise you to go to the nearest hospital Emergency Room, immediately or dial       9-1-1 for help.

 

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Please provide the best number to reach you.

This information is needed to determine whether there is a difference in Time Zones.

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Please indicate the type of Counseling you are seeking--Individual, Couples/Marriage, or Pre-Marital

Please indicate what has led you to seek therapy at this time.

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Once you have submitted your form, you are ready for your Initial Consultation! You will be contacted via e-mail to set up your appointment within 48 hours (excluding Sunday).

Copyright to Sophia Avery. All rights reserved.

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2449 Golf Road
Suite 3
Philadelphia, PA 19131

ph: 215-931-3070