Toll Free Number - 888.891.4673

Forms for New Clients

Only Two Required Forms for New Clients

Once completed, you may return your forms to one of the three choices below:

  • Mail – PO Box 43, Oxford MS 38655
  • Email – rob.jackson (AT) christiancounsel (DOT) com
  • Fax – 888.891.4673


1. Download, print, and return a signed copy for each adult who will be attending the intensive. Spouses may sign the same copy.


2. Download and print one copy for each person who will be attending the intensive. Feel free to omit items that aren’t relevant to a particular individual. Please return your completed intakes Noon on the Friday that precedes your intensive.

One Form Required to Release and/or Exchange  Information to Service Providers

3. If you’d like for me to follow-up with a family member, local therapist, doctor, pastor, or accountability parter, complete and return this form. Each adult who participated in the intensive will need to sign this form.