Coaching & Counseling - Converge Coaching

My Counselor - Faith-Based Online Therapy-3

Converge Coaching and MyCounselor.Online are proud to partner with your referring organization to provide access to excellent coaching and counseling!

Below you will find a simple form that takes about 3 minutes to complete. Once we receive your form submission our intake team will reach out to you with the next steps.

We’re looking forward to serving you!

Name(Required)

First Last

Email(Required)

Phone(Required)

Referring Organization(Required)

Scholarship Program Code

Who are we meeting with?(Required)

Me (The person completing this form)

My Spouse and I (Marital)

My Spouse

My Teen/Adult Child

Coaching or Counseling(Required)

Coaching - Do you seek guidance to enhance your skills, set personal and professional goals, and maximize your potential? Coaching focuses on growth and performance to help you achieve specific outcomes in your personal or work life. Topics might include: Burnout, Stress Management, Proactive SoulCare, Personal and Leadership Growth, Transition Planning, Sabbatical Prep, etc.

Counseling - Do you or a family member need support to work through personal challenges, emotional difficulties, relational or mental health concerns? Counseling provides a safe space and practical direction for exploring your feelings, understanding patterns, and addressing various emotional or relational issues. Topics might include: Anxiety, Depression, Marital Conflict, Teen Struggles, Sexual Difficulties, Porn Use, Grief, etc.

Counseling with MyCounselor.Online

Help for you or a family member needing support to work through personal challenges, emotional difficulties, relational or mental health concerns. Counseling provides a safe space and practical direction for exploring your feelings, understanding patterns, and addressing various emotional or relational issues. Topics might include: Anxiety, Depression, Marital Conflict, Teen Struggles, Sexual Difficulties, Porn Use, Grief, etc.

Client Information

Client Name(Required)

First Last

Client Email(Required)

Client Phone(Required)