In person or telephone consultation for pastors and churches

Dr. David Sylvester

Founder

Dr. Sylvester has worked more than 45 years in pastoral ministry as a lead pastor and executive pastor in large and growing churches, provided pastoral counseling and is a writer of teaching resources and as co-writer for two books. Dr. Sylvester studied at the University of Mary-Hardin Baylor, Texas State University, Wayland University, and has master and doctoral degrees from Southwestern Seminary in Fort Worth, TX. For in-person counseling appointments, please email or call Dr. Sylvester using the contact information below.

Email: davidsylvester2@yahoo.com

Cell: 817.253.7483
Counseling Fee Per Session $90

Counseling Information Form

Personal Information

Full Name

Today's Date

Street Address

City

State

Zip

Mobile Phone

Home Phone

Primary Email

Age

Gender

MaleFemale

Marital & Family Information

Marital Status

MarriedSingleSeparatedDivorcedWidowedIn a RelationshipEngaged

Spouse's Name

Years Married

Children

Child 1

Name

Age

Child 2

Name

Age

Child 3

Name

Age

Child 4

Name

Age

Child 5

Name

Age

Occupation

Employer

Emergency Contact

Name

Cell

Relationship to Me

Referred By

Pastor or ChurchFamily or friendOther

If Other

Family of Origin

Place of Birth

Describe your Father

Describe your Mother

Siblings

Sibling 1

Name

Age

Sibling 2

Name

Age

Sibling 3

Name

Age

Sibling 4

Name

Age

Sibling 5

Name

Age

Family History (Optional)

Alcohol/Substance habitsAnxious feelingsDepressed feelingsDomestic harmSexual abuseUnhealthy eating habitsCompulsive tendenciesSchizophrenia-type behaviorSuicide thoughtsDivorce

Which Family Member?

Spiritual Life

Raised In What Church?

How Do You Practice Your Faith (if any)?

Church I Now Attend (if any)

My Need Today

Please check up to 5 items.

Feeling inferior to othersConfused about unhealthy or improper thoughtsPersonal pressure / stressFeeling down or unhappyRelationship conflicts with spouse/partnerFeeling nervous or anxiousSame-sex attraction feelingsLonelinessFeelings related to sexual abuse/useGuilty feelingsThinking about divorce / healing from divorceProblems with childrenOngoing angerFeeling hopeless or lacking directionFinancial issuesMajor illness / fear of what's nextEmotional instabilityConfused about faith / Bible teachingsAddiction problemsCommunication conflictsGuilt over bad decisionsWondering if God has given up on meProblems with parents / partner’s parentsLegal problemsOther

If Other

Acknowledgement of Liability

Please be advised that the counsel or advice offered by Dr. David Sylvester is faith-based counseling offered from a Christian and biblical perspective. Dr. Sylvester is not licensed by the State of Texas or other body as a professional counselor, therapist or mental health provider. As such, the services offered should not be considered a substitute for professional mental health care, diagnosis, or treatment. Dr. Sylvester assumes no liability for any actions, decisions, or outcomes resulting from the counsel provided or the results achieved. Further, Dr. Sylvester does not participate in any form of medical insurance and does not represent his counsel or services as qualified for insurance benefits. By participating in these sessions, you acknowledge and accept these terms.

I acknowledge and accept these terms.

Signature

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