Biblical Counseling Waiting List Support

Waiting List Support Questionnaire

Before completing this questionnaire, please read the Privacy Policy. This form may include sensitive information about your wellbeing, faith, family life, health, safety, and support needs. Your answers will be used to help Caroline understand your situation, manage the waiting list responsibly, and, where appropriate, offer interim biblical guidance while you wait.

This questionnaire is not emergency support, is not monitored 24/7, and is not a medical diagnostic tool. If you are in immediate danger, feel unable to keep yourself safe, have taken an overdose, are seriously injured, or believe someone else is at risk of harm, please call 999, go to A&E, contact your GP urgently, or use NHS 111 mental health support.

I understand that this form is not emergency support. I understand that this form does not provide a medical diagnosis. I understand that Caroline may not be able to respond immediately. I consent to Caroline reading my answers and using them to understand my needs, manage the waiting list responsibly, and, where appropriate, offer suitable waiting-list guidance. I understand that confidentiality may need to be limited if there is serious risk to me, a child, a vulnerable adult, or another person. I confirm that I have read the Privacy Policy and consent to Caroline Kent using the information I provide in this questionnaire for the purposes described above.

Your answers will be treated carefully and confidentially, except where there is serious concern about your safety, the safety of a child or vulnerable adult, or the safety of another person.

Consent

I understand that this form is not emergency support. I understand that this form does not provide a medical diagnosis. I understand that Caroline may not be able to respond immediately. I consent to Caroline reading my answers and using them to offer suitable waiting-list guidance. I understand that confidentiality may need to be broken if there is serious risk to me, a child, a vulnerable adult, or another person.

Basic details

Full name

Email address

Phone number

Preferred method of contact

Age

Are you completing this for yourself, your child, or someone else?

If completing for someone else, what is your relationship to them?

Are you currently on the counselling waiting list?

Have you had counselling with Caroline before?

Are you currently receiving support from anyone else?

Immediate safety

Please answer these as honestly as you can. If there is immediate danger, please seek urgent help now rather than waiting for a counselling response.

Main areas of struggle

Please rate each area from 0 to 4. 0 means not a problem. 4 means overwhelming.

Daily functioning

Please rate how much your struggles are affecting ordinary life from 0 to 4.

What is the hardest part of an ordinary day at the moment?

What tends to make things worse?

What tends to help, even a little?

Are there particular times, places, people, memories, or situations that trigger distress?

Faith, church, and spiritual support

Do you currently believe you are a Christian?

Do you currently attend a church?

Do you have a pastor, elder, mature Christian friend, or trusted church member who knows something of your struggle?

What is your current experience of God?

Medical, practical, and support context

Have you spoken to your GP or another professional about this struggle?

Are you taking any medication that affects mood, sleep, anxiety, pain, hormones, or concentration?

Have there been any recent major life events, losses, traumas, illnesses, family changes, court matters, police involvement, safeguarding concerns, or bereavements?

Are there any health factors I should be aware of?

Do you have any diagnosed or suspected neurodivergence or learning needs?

Would any of these adjustments help?

Larger text Shorter written material Simpler language Slower pace Audio support Fewer forms

Biblical counselling for individuals, couples, children and young people

Waiting List Support Questionnaire

Consent

Basic details

Immediate safety

Main areas of struggle

Daily functioning

Faith, church, and spiritual support

Medical, practical, and support context

What would help most while you wait?

Books and Resources

How to Cast Your Care

Science / Faith or Both?

What Time I Am Afraid I Will Trust in Thee

Biblical counselling for individuals, couples, children and young people

Waiting List Support Questionnaire

Consent

Basic details

Immediate safety

Main areas of struggle

Daily functioning

Faith, church, and spiritual support

Medical, practical, and support context

What would help most while you wait?

Receive Biblical Encouragement by Email

Books and Resources

How to Cast Your Care

Science / Faith or Both?

What Time I Am Afraid I Will Trust in Thee