Biblical Counseling Waiting List Support

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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.

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 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.

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

What would help most while you wait?

A simple Scripture reading plan Short prayers when I cannot find words Help with anxiety and panic Help with intrusive thoughts Help with guilt and shame Help with assurance Help with trauma and feeling unsafe Help with grief Help with sleep and daily routine Help talking to my pastor or church A short written biblical counselling plan

Is there anything else you would like Caroline to understand before offering written guidance?

Would you be willing for Caroline to suggest other support if your answers indicate this would be wise?

Website

Thank you. Your form has been submitted. Please remember that this is not emergency support. If you are in immediate danger or feel unable to keep yourself safe, please call 999, go to A&E, contact your GP urgently, or use NHS 111 mental health support.

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Biblical counselling and pastoral support, available online with warmth, clarity, and care.

Join the Waiting List

Counselling with Caroline Kent Copyright 2026
Online biblical counselling · Biblical Counseling Coalition Partner

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