Start Your Intake Process Here

As we try to exemplify throughout our entire ministry, Reformed Presbyterian Global Missions is committed to the whole-person health of our staff. Toward that commitment, we have partnered with Global Counseling Network to provide subsidized counseling sessions for all of our team members. GCN counselors are trained, seasoned, vetted, and prepared to help you better understand and navigate seasons of life so that you might flourish in ministry and all of life.

This partnership provides:

8 fully covered sessions for individual counseling
6 fully covered sessions for couple or family counseling

Once you have completed your covered sessions, you have the option to continue meeting with your counselor at his or her private pay rate.

Here’s what you can expect:

Fill out the form below to begin the intake process.
Within 2 business days, a GCN intake coordinator will email you to help you choose a counselor and get started.

We hope you will find this a helpful resource and look forward to any feedback you have.

Important Notice:

GCN is an entirely online practice, and all counseling sessions are conducted through video communication. While our counselors are experienced in supporting a wide range of mental health and relationship concerns, please note that we are not equipped to provide ongoing care for individuals who are actively suicidal. If this situation arises during your treatment, we will work with you to transition to the appropriate level of support. However, we are unable to begin treatment for individuals who are actively suicidal.

By continuing with this form, you acknowledge that you have read and understood this notice.

What is your name?

First Name

Last Name

Preferred Name or Nickname (if applicable):

What is your email address?

Phone

(###)

###

####

Address (Where you will be located when you have sessions)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you 18 or older?

Yes

What type of counseling are you seeking?

Individual Counseling (for yourself)

Couple or Family Counseling

If you are seeking couples or family counseling, please provide the following details for each participant:

Name(s) Relationship(s) to you Location (if different) Email(s)

What brings you to counseling?

Please provide a brief description of the issues you're hoping to address

On a scale of 1-10, how would you rate your current level of emotional distress?

(1 = Minimal distress, 10 = Extreme distress)

What is contributing to your emotional distress?

Is there anything else you'd like us to know?

(For example: therapy preferences, previous mental health history, etc.)

What days and times are you generally available for counseling sessions?

(Please include preferred time zones.)

Have you previously worked with a GCN counselor? If yes, please include the counselor’s name:

Preferred Gender of Counselor?

Male

Female

No preference

If you have a certain counselor you would like to see, please list below. If not, we will offer some recommendations.

1. I understand that GCN is an out-of-network provider and does not file insurance claims on behalf of clients.
2. I acknowledge that many insurance policies offer coverage for out-of-network mental health services. It is my responsibility to verify with my insurance provider before beginning counseling.
3. I understand that if I wish to use out-of-network benefits, I must inform my intake coordinator before choosing a counselor.
4. I understand that GCN can provide documentation for insurance claims, but GCN cannot guarantee that my insurance will cover the cost of services.
5. I understand that I am financially responsible for the cost of counseling services in the event that insurance or financial assistance does not cover the full cost.

Yes

I want to receive updates and resources from GCN!

Yes, I do! As long as you don’t give it out to anyone else.

By submitting this form, I confirm that I understand and agree to the above points and am ready to begin counseling with GCN.