Problem Statement
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Name
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Today's Date
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Questions
1. How did you hear about our Brighter Day Counseling Ministry?
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2. Why are you seeking help? What's the problem?
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3. How long has this been a problem?
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4. What have you done about this issue? How have you tried to fix it?
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5. How Can we help? What are your expectations in coming to us?
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6. How do you see yourself? What kind of person are you? (Please describe yourself)
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7. Is there other information we should know that will help us understand you and/or the situation better?
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Do you attend church two or more times a month?
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Please select one option.
Yes
No
Select Option
Yes
No
Submit
Description
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