💬 About Our Counseling Ministry

Our counseling ministry exists to provide Christ-centered, grace-based guidance to individuals and families facing life’s challenges. We believe that true healing and lasting change come not through human wisdom alone, but through the truth of God’s Word and the power of the Holy Spirit.

We offer a safe, confidential, and compassionate environment where people can:

Explore personal struggles
Receive biblically grounded counsel
Experience God’s love, restoration, and direction

Whether you’re dealing with emotional pain, relational conflict, spiritual confusion, or personal crisis, we walk with you toward clarity, healing, and freedom in Christ. Our goal is not behavior modification, but heart transformation, rooted in your new identity in Jesus.

“He sent His Word and healed them…” — Psalm 107:20

Personal Data Inventory

Why We Require This Form

At Simon Mbatia Ministries and its affiliates, we believe that counseling is a sacred partnership—not a quick fix, but a Spirit-led journey toward healing, clarity, and transformation through Christ.

This Personal Data Inventory Form helps us walk wisely and compassionately with you. Here’s why it’s essential:

1. To Understand Your Story More Accurately

Every individual is unique. By sharing details about your background—spiritual, emotional, physical, and relational—we gain a clearer picture of your situation. This enables us to approach your concerns with wisdom and grace, not assumptions or generalizations.

2. To Provide Biblically Sound, Tailored Counsel

Our commitment is to offer truth-based, Spirit-led guidance, not one-size-fits-all advice. Knowing your history and current challenges allows us to speak God’s truth into the specific places where His light is most needed in your life.

3. To Discern Whether Referral or Specialized Help is Needed

Some issues—legal, medical, or psychiatric—may fall beyond our spiritual care mandate. This form helps us discern whether outside support is necessary for your well-being and safety, while still walking with you in prayer and encouragement.

4. To Build a Trust-Based Relationship

Mutual trust is the soil where spiritual counsel flourishes. By filling this form, you are giving us the tools to minister with integrity, discretion, and relevance—and we promise to treat your information with the utmost confidentiality and care.

“Plans fail for lack of counsel, but with many advisers they succeed.” — Proverbs 15:22

We’re not here to judge your past—we’re here to walk with you toward the future God desires for you: whole, free, and restored in Christ.

Thank you for taking this first courageous step.

PERSONAL BACKGROUND

Name *

Phone *A number we can use to reach you confidentially

Street Address

City *

State/Province

Country *

Occupation: *Your current work or role, whether employed, in ministry, homemaker, student, etc.

Marital Status: *Please indicate your current relationship status.

If married:

Your age when married:This helps us understand your family timeline and context.

Partner's age when married:

Is this your first marriage?Answering helps us better support blended or complex family backgrounds.YesNo

Do you have children? *YesNo

If yes, list number and their ages:Include number and ages. This gives us context for your family life.

Why have you come for counseling? (Briefly describe your situation) *Briefly share the issue(s) that brought you here. Be honest and open—this is a safe space.

What have you done about it so far? *Let us know how you’ve tried to address or cope with the situation.

What would you like us to do for you? (Your expectations from counseling) *Tell us what you’re hoping to receive through counseling—clarity, healing, direction, etc.

Have you seen any other counselor for this issue? *YesNo

If yes, give details:If yes, please share who, when, and the general outcome or advice given.

HEALTH BACKGROUND

How would you describe your health?Select the option that best reflects your general physical condition.

Last medical examination:Enter the date of your most recent doctor’s visit or check-up.

Day

Month

Year

Result of the examination:Please summarize the outcome of your most recent medical check-up. This may include any diagnoses, health concerns raised, or advice given by your doctor. This information helps us understand any physical conditions that may be affecting your emotional or spiritual well-being.

Are you currently on any medication? *YesNo

If yes, list medications:If yes, list what you’re taking and why. This helps us understand potential physical factors.

Have you taken drugs for non-medical reasons? *If applicable, please explain your experience briefly and honestly. There’s no judgment here.YesNo

If yes, explain:

Any recent weight gain/loss? *This helps identify possible physical or emotional health indicators.YesNo

Details: *

Current physical issues (e.g., sleeplessness, menopause, etc.):

SPIRITUAL BACKGROUND

Do you believe in God? *Let us know your general belief or worldview.YesNo

Have you received Christ as your Saviour? *This helps us know where you are in your walk with Christ so we can offer guidance that truly fits your spiritual journey.YesNo

If you were to die today, are you sure you'd have eternal life? *Answer as honestly as you can. We’re here to walk with you either way.YesNo

Explain why or why not: *Share what gives you confidence—or what causes you doubt—about your eternal future.

Have you been baptized? *Let us know if and when you’ve taken this important step of faith.YesNo

Do you attend church? *This helps us understand your current connection to a spiritual communityYesNo

If yes, name of church: *

How often do you attend? *This gives us a sense of how regularly you’re able to receive fellowship and teaching.

How often do you read the Bible?This helps us understand how you engage with God’s Word in your daily life.

How often do you pray? *This gives us insight into your ongoing communication with God.

Describe your relationship with Jesus Christ: *In your own words, help us understand how close or distant you feel from Christ right now.

Is there anything else we should know about your situation? *Feel free to share anything that hasn’t been covered but feels important to mention.

IMPORTANT NOTES

Limits of Confidentiality:
All information shared is confidential and will only be disclosed with your permission—except in cases involving self-harm, harm to others, or criminal activity where authorities must be notified.
Disclaimer:
We are not psychologists or psychiatrists. Our counseling is based on the Bible, which we believe provides sufficient guidance for every area of life.

DECLARATION

Declaration *I have read and understood the confidentiality and disclaimer statements. Tick this to confirm that you understand how your data will be handled and that you’re participating voluntarily.

Name

Date

💬 About Our Counseling Ministry​