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Covenant Counseling

Questionnaire

Name: _____________________________________________

Briefly answer the following questions: (If you need more room, feel free to use another page.)

1. What is the main problem, as you see it? What brings you here?

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2. What have you done about it?


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3. What can we do? What are your expectations in coming here?


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Covenant Counseling
Questionnaire

4. As you see yourself, what kind of person are you? Describe yourself.
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5. Is there any other information we should know?

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