Destiny Biblical Counseling

Rocklin Campus

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Nancy Short

Nancy Short Biblical Counselor & Coaching

Nancy Short has been serving and leading in ministry for over 25 years in a variety of capacities including prayer and intercession ministry, chaplaincy, teaching discipleship classes, mentoring, and fitness and wellness ministry. She has a passion for encouraging, equipping and empowering people to grow in their relationship with God, to know their identity and freedom in Christ, to experience healing and restoration from trauma and brokenness, to cultivate devotion for studying and praying God’s Word, to practice God’s presence, and to fully live the John 10:10 abundant life in Christ. Nancy enjoys inspiring and guiding others on their spiritual journey especially for discovering how depending on God’s Word as Holy Spirit leads us enables us to navigate all of life’s circumstances with faith, peace, and hope in Christ.

Please Note: All Appointments Require a $50 Fee to be Paid at the Time of Each Session Via Cash, Credit Card or Check. Thank You for Supporting the Counseling Ministry.

To book a First Time Appointment with Nancy, click on the "First Time Appointment" button , fill out the Intake Form below, pay the required fee and click the submit button. Nancy will contact you to make your appointment

To book a Repeat Appointment with Nancy, click on the "Repeat Appointment Payment" button , fill out the Intake Form below, pay the required fee and click the submit button. Nancy will contact you to make your appointment

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Nancy* $51.75 ($50.00 + $1.75 fee)

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Explain

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Religious Background

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Current Religious Affiliation:*

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Daily Relationship with God?*

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What concerns have led you to pursue counseling?*

Where is this impacting you the most? Check all that apply*

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Work
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God
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When did this begin to be a problem for you?*

Please rate the severity of your present concerns.*

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What do you hope to gain from counseling.*

If other people are involved in your present problem, who are they and how could they help improve the situation?*

Medical/Health Information

Are there chemical substance abuse issues in your family?*

If yes, who?

If clean/sober, for what length of time?*

Have you ever been hospitalized for mental illness or substance abuse?*

If yes, for what specific reason and where?*

Are you currently taking any Mental Health Medications ?*

Please list these Medications :*

Have you ever participated in counseling before?*

If so, when and why?*

Name of Therapist

Please indicate which of the following areas are currently problems for you. Check all that apply:*

Under too much pressure/feeling stressed
Excessive anxiety or worry
Feeling lonely
Angry feelings
Concerns about finances
Feeling "numb" or cut off from emotions
Angry outbursts
Excessive fear of specific places/objects
Difficulty making friends
Feeling as if you'd be better off dead
Feeling that people are "out to get you"
Feeling manipulated or controlled by others. Difficulty making decisions
Loss of interest in sexual relationship
Feeling sexually attracted to members of your own sex
Concerns about physical health
Loss of appetite/increased appetite
Lacking self confidence
Recent significant weight gain/lose
Use of alcohol
Use of non-prescription/prescription drugs
Feeling distant from God
Hallucinations
Inability to concentrate while at school/work
Crying spells
Nightmares
Loss of interest in usual activities/lack of motivation
Obsessions or compulsions with specific activities or thoughts
Inability to control thoughts
Feeling trapped in rooms/buildings
Hearing voices
Blackouts or temporary loss of memory
Sleeping too much or too little
Feeling driven

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Terms and Conditions

Terms and Conditions*

The Counselor is not providing legal, tax, medical, or other technical or professional advice.

The session content will be held confidential; however, limitations of such client held privilege of confidentiality exist and are itemized below:

1. If a client threatens or attempts to commit suicide or otherwise conducts him/herself in a manner in which there is a substantial risk of incurring serious bodily harm.

2. If a client threatens grave bodily harm or death to another person.

3. If the Biblical Counseling Minister has a reasonable suspicion that a client or other named victim is the perpetrator, observer of or the actual victim of physical, emotional, or sexual abuse of children under the age of 18 years.

4. Suspicions of elder abuse (60 and older) as in the case stated above (#3).

5. Suspected neglect of the parties named in items #3 and # 4.

6. Your Destiny Biblical Counselor (DBC), reserves the right to discuss your case with other DBC team members in order to come up with the best solution and strategies that will have the greatest impact of success for your specific situation. Your information and case is still strictly confidential outside of the DBC team.

I agree to hold Destiny Christian Church and its team members free from any and all liability, loss or damage of any kind that may arise as a result of assistance which I have received or from my involvement with the Destiny Biblical Counseling Team.

I have read and agree to the terms above.

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