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Problem Description

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Information About Children:


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What: Frequency:

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* Permission to contact your pastor includes sharing information on this PDI.

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Women Only

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Problem Checklist

Please select areas you are struggling with.

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Counseling Agreement

Consent to Counseling

Our Goal

Our goal in providing biblical counseling is to help you meet the challenges of life in a way that will please and honor the Lord Jesus Christ and allow you to enjoy fully His love for you.

The Biblical Basis of Our Counsel

Our counseling is strictly based upon God's Word. We believe the claims of Scripture in its promises, precepts, principles, and wisdom is the all-sufficient truth that provides everything we need for living a godly life (2 Peter 1:1-4). We believe that change is provided through God's enabling grace, the Scriptures, the ordinances, God's people, and God's providence. There are no problems that the Bible fails to address, either in general or specific principles. Therefore, all counseling at the Chapel Counseling Center will be conducted under the authority of the Scriptures. The Scriptures are the final authority in all matters of truth and life. Counseling will be done under the counselor's understanding of the Scriptures.

We are not psychologists nor psychiatrists. However, our counselors are either certified or trained in accordance with the standards of conduct and philosophy of the Association of Certified Biblical Counselors, the certifying agency for Biblical counselors.

Not Professional Advice

Some of our counselors work in professional fields outside of the Center. When serving as counselors at the Center, they do not provide the same kind of professional advice and services that they do in their professional capacities. Therefore, if you have significant legal, financial, medical, or other technical questions, you should seek advice from an independent professional. Our counselors will be happy to cooperate with such advisors and help you to consider their counsel in the light of relevant scriptural principles.


Confidentiality is an important aspect of the counseling process, and we will carefully guard the information you entrust to us. There are five situations, however, when it may be necessary for us to share certain information with others:

  1. When a counselor is uncertain how to address a particular problem and needs to seek advice from another counselor, or one of the elders of Clearcreek Chapel.
  2. When a counselee attends another church and it is necessary to talk with someone in leadership at that church.
  3. When there is a clear indication that someone may be harmed unless others intervene.
  4. When a person persistently refuses to renounce a particular sin and it becomes necessary to seek the assistance of others in their church to encourage repentance and reconciliation (Proverbs 15:22; Matthew 18:15-20).
  5. By law, we are required to report child abuse to the authorities. Please be assured that our counselors strongly prefer not to disclose personal information to others, and they will make every effort to help you find ways to resolve a problem as privately as possible.

Help from Your Local Church

The resource of God's people is vital to godly change. The Scriptures teach that a local body of believers have the responsibility to come alongside those who are struggling with issues in their lives (Galatians 6:1-3). No one is alone in their struggle. God has equipped each local church body with those who have the gifts necessary to help those who are struggling. He also gives the directive for each one to come alongside others who are struggling. To deprive the body of Christ the opportunity to minister to others will deprive the struggling person of a powerful resource for change in their life. It will also deprive those who have the ability to minister, the opportunity to be used of God in the lives of others.

The leadership of that local church is accountable to God for those who are under their care (Hebrews 13:17). It is not the responsibility of the Chapel Counseling Center to usurp the leadership of their responsibilities toward the sheep in their care.

If you are a member of another church, it will be necessary for you to have mature Christians from your local church (Support Partner) act as observers and mentors while you are being counseled. We believe in the blessing the authority of your local church has in your life and want to enhance that relationship. This also makes the transition of counseling care to your local church a more transparent process. If you are not connected to a local church, you should plan on attending one service per week at Clearcreek Chapel during the time of your counseling (exceptions may be made depending on the circumstances).

Responsibilities of the Support Partners

Those who are willing to accept the opportunity of participating as your Support Partners will have the following responsibilities:

  1. Attend all counseling sessions with you.
  2. Observe your counseling sessions in order to hold you accountable for the weekly homework assigned. These Support Partners will be available if you need assistance with your homework.
  3. Come to your aid in situations that arise during the week to help you when life seems to be getting out of control or you need help putting into practice what has been taught.
  4. Give feedback to your counselor whenever something taught in the session is not in line with what is being taught in your local church. This will alert your counselor of a potential conflict.
  5. Keep your local church leadership updated on your progress as they deem appropriate.
  6. When your counselor has determined the crisis, for which you initially sought counsel, has been adequately addressed, counseling will be terminated and your Support Partners will have the responsibility to continue any regular discipleship they believe is necessary as a part of the care of your local church.


Clearcreek Chapel is a non-for-profit tax-exempt church body dedicated to the faithful proclamation of the Gospel of Jesus Christ through ministry to individuals and families who are in need of spiritual help. It is the purpose of the Chapel Counseling Center to provide competent Biblical counsel, to those who seek it, at no charge. This is done for the benefit of the Body of Christ in our local area. We want to make you aware though, that there are costs that we do incur such as: secretarial staff, counselor training, resources for counselors and counselees, etc. If you can help cover these expenses by making a donation, if would be greatly appreciated. Checks should be made out to Clearcreek Chapel. Do not make your checks out to any counselor or individual members of Clearcreek Chapel or the counselor's church. Members are not expected to make a donation, since it is their membership responsibility to contribute during regular services. If you are in need of further clarification of this statement, please see the Director of the Center.

Resolution of Conflicts

On rare occasions a conflict may develop between a counselor and their counselee(s). In order to make sure that any such conflicts will be resolved in a biblically faithful manner, we require all of our counselees to agree that any dispute that arises with a counselor or with Clearcreek Chapel, as a result of counseling, will be settled by mediation and, if necessary, legally binding arbitration in accordance with the Rules of Procedure of the Institute for Christian Conciliation, a division of Peacemaker Ministries. Judgment upon an arbitration award may be entered in any court having jurisdiction. A copy of the Rules of Procedure is available at

Termination of Counseling

The counselor, or counselee, for reasons sufficient to themselves, may terminate counseling at any time. Termination of counseling also refers to ending the counseling sessions when the crisis situation(s) for which you initially came for help, have been adequately solved. We refer to this ending of counseling as your Graduation.


By signing this consent, you agree that you will not attempt to subpoena or require any counselor to appear in any legal proceeding related to any matters discussed during counseling; nor will you attempt to subpoena any notes or records related to this counseling. Clearcreek Chapel Counseling Center is not required by law to and does not retain or release counseling records.

Having clarified the principles and policies of our counseling ministry, we welcome the opportunity to minister to you in the name of Christ and to be used by Him as He helps you grow in spiritual maturity and prepares you for usefulness in His body. If you have any questions about these guidelines, please talk with the Director of the Center. If these guidelines are acceptable to you, please sign and date below.

Electronic Signature

I, , have carefully read the conditions for counseling set forth on this page and agree to enter into counseling in accordance with them.

I am filling out this form on behalf of the counselee:   


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Thank you for taking the time to fill out this form! Your complete and honest answers will aid the counseling process and allow the counselor to better understand you and your situation.

We encourage you, if you have not already, to go back and review your answers. Once you click "Finish" an email will be sent to the counseling office at Clearcreek Chapel. If you filled in your email address under the Personal section, you will receive a copy of your PDI.

The counseling administrator will contact you to set up a meeting time and location that is convenient for both parties. If you have any questions or concerns, please do not hesitate to contact our counseling office.

Click "Finish" to submit your Personal Data Inventory.