George Adaza

George Adaza Biblical Counselor

My name is George Adaza. I was born and raised in Southern California. My life would best be described by various chapters. My early childhood was marked by physical and verbal abuse. I joined the military immediately after graduating high school. I served four years in the US Air Force. In 1970, I married my first wife, our marriage ended after 20 years because of marital unfaithfulness on her part, as painful and difficult as the first part of my life was at times, I can testify to God's faithfulness and see his hand over my life the entire time. In 1992, I remarried and have been happily married to my wife Celia, for 34 years now; we attended a church in Elk Grove for 32 years. During this time, we were home group leaders for nearly 20 years; we served on prayer teams and were involved in men’s and women’s ministries. God gave us the opportunity to see many wonderful miracles during this time by praying with and encouraging couples and individuals experiencing the trials of life.

Please Note: All Appointments Require a $25. 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 an appointment with George, please fill out the Intake Form below and submit it. You will then be taken to the booking website to make your appointment.

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Intake Form

George Adaza*

Counselor

Intake Form Date

Name

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Address

Date of Birth

Age

Gender

Male
Female

Number of Marriages Including Current

Spouse's Name

Spouses Age

Years Married

Names and Ages of Children/and or Step Children

Explain

Who referred you to Destiny Biblical Counseling or how did you hear about us?

Religious Background

Previous Religious Affiliation (ie. Catholic, Mormon, Jehovah Witness, Muslim, etc..):

Current Religious Affiliation:

Are you Saved and When?

Have you been Baptized and When?

Daily Relationship with God?

Level of Activity

Active
Inactive

Do you attend a local church?

If yes, name of church

How long have you attended your present church?

How significant is your religion to your everyday life?

Occupational Information

Occupation

Employer

How Long?

What concerns have led you to pursue counseling?

When did this begin to be a problem for you?

Please rate the severity of your present concerns.

Mild
Moderate
Severe

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

Any other information that you feel is important to share that is not covered?

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.

Almost done. Where should we send the confirmation?

Name

Mobile Phone Number