Destiny Biblical Counseling Sacramento Campus

Lisa Tafoya

Lisa Tafoya Doctor of Ministry in Apostolic Leadership

Many people struggle with a wide range of issues that hinder their relationships, both in

public and in private settings. God desires for us to know who we are in Him. We all

have a testimony, and there is no condemnation in Christ Jesus. Every person has

DESTINY and PURPOSE, is made in the IMAGE OF GOD, and is called into the BODY

OF CHRIST. My goal is to bring healing and revelation through God’s Love by

understanding Scripture, listening, forgiveness, repentance, and alignment. No matter

who you are, what you have been through, or where you are in life—God sees you and

is intimately aware of you. YOU ABSOLUTELY MATTER. When the Holy Spirit has

permission to work out the things in us that do not align with the Bible, miracles start

happening! Jesus gave His Life for us so that we can live according to His perfect will.

Come, let us reason together so we can defeat the enemy through the Blood of the

Lamb and the word of our testimony. Let’s conquer the enemy that has been trying to

conquer you!

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 a first time appointment with Lisa, please fill out the Intake Form below, pay the required fee and submit it. Lisa will contact you to make your appointment.

To book a repeat appointment with Lisa, please fill out the Intake Form below, pay the required fee and submit. Lisa will contact you to book your appointment.

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Lisa Tafoya* $25.88 ($25.00 + $0.88 fee)

Doctor of Ministry in Apostolic Leadership

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Age*

Gender*

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Number of Marriages Including Current

Current Marital Status*

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Spouse's Name*

Spouses Age*

Years Married*

Names and Ages of Children/and or Step Children*

Presently Living with:*

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Spouse
Roommate
Alone
Other:

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?*

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

Home
Work
Marriage
God
Other

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

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

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

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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