Instructions for Completing and Mailing Intake Form
Please confirm our availablility to your situation at 706-692-7960. After you have done so, download, complete and sign our intake form. Please mail the entire intake form without removing any pages. When you mail your intake form, please mark the envelope as CONFIDENTIAL and mail to:
Bread of Life Counseling Center
c/o Foothills Community Church
13724 Hwy 53
Marble Hill, GA 30148
Once your intake form is received by mail, we will begin the process of scheduling. If there is a waiting list, scheduling will be dealt with on a first come-first served basis or as dictated by need. On the last page of this form there is a box for you to indicate what appointment times are best for you. Please offer as much flexibility as possible and we will attempt to accommodate these times if our schedule allows.
Please keep in mind that your sessions may be provided by one of our trained and qualified “Lay counselors,” or you may see one our professional counselors, Dr. Gary Battaglino.
Our Ministry Team Members
In addition to our staff counselors. The Bread of Life Counseling Center utilizes lay counselors to provide Biblically based care and encouragement to men and women in our community. Our lay counselors are carefully trained, going through extensive and ongoing education. They are closely monitored and mentored by our professional counseling staff.
Our lay counselors do not possess professional licenses or certifications issued by the State of Georgia for the practice of professional counseling, marriage and family therapy, or social work specialties; nor do they necessarily possess the required education, experience or training for such licenses. If Dr. Battaglino is not available, and you do not wish to work with one of our lay counselors, we will be happy to refer you to outside professional providers. Our lay counselors are under the direct supervision of Dr. Gary Battaglino.
The Bread of Life Ministry does not claim to meet any counseling requirements for court/probation/parole=mandated counseling. We do not render any financial, legal or medical opinions and/or advice.
What is Expected of You?
It is our belief that change must begin with ourselves as we look to Christ for the power to change. Therefore, we ask you to approach the counseling and encouragement process as an opportunity for personal change and spiritual growth. We ask that you refrain from the temptation of focusing on others, and instead we ask you to focus on what changes God desires to make in your life, in the midst of your circumstances.
Be advised that you may be assigned “homework.” Homework is a vital part of the change process; therefore, completion of the homework assignments before your next session is expected.
Availability
Our ministry, at times, may carry a waiting list. If our waiting list is prohibitive, we will offer outside referral options. Our ministry is available on an appointment basis. Each session will typically last 50-60 minutes.
If you need to reschedule or cancel an appointment, we ask that you call at least 24 hours in advance. This allows us to reschedule others who may be waiting for an appointment slot to open. Repeated failure to keep appointments or give proper notice of cancellation may result in termination of sessions.
Confidentiality
The information you share with your lay counselor or professional counselor will be carefully guarded and cannot be disclosed without your written consent, with the following exceptions.
1. It is required by Georgia Law that all counselors have a duty to warn the appropriate individuals if they counselee intends to take harmful, dangerous, or criminal actions against themselves or someone around them. Lay counselors and professional counselors are also mandated to report any incidences of “reasonable and professional counselors are also mandated to report any incidences or “reasonable suspect child abuse” (physical or sexual), elder abuse, or suicide attempts.
2. To insure the highest quality counseling process, as a rule your lay counselor will consult with their counseling supervisor regarding your sessions.
3. We reserve the right to consult with our counseling professionals or appropriate church ministry staff members regarding your sessions. This consultation will be held in the same level of confidence as your sessions.
Resolution of Disagreements
If a dispute should arise between the person receiving ministry and the pastoral lay counselor regarding the session or the Lay counselor’s advice or conduct, one should bring this dispute to the attention of the Director of the Bread of Life ministry board. If the dispute cannot be resolved at this level, all parties agree to resolve such dispute by submitting to the Church’s Senior Pastor and Church deacons for full and final resolution and conciliation. Director of board: James Brown, 706-692-7960.
Waiver of Liability
The undersigned, having sought biblical counseling as such as adhered to by the Bread of Life Counseling Center, a nonprofit religious organization, hereby acknowledge their understanding of the following conditions and further releases from liability the Bread of Life Counseling Center, its pastors, agents, employees, or board members from a claim or litigation whatsoever arising from the undersigned’s participation in the above-mentioned biblical counseling ministry. It is further understood:
In consideration for receiving any form of counseling from the Bread of Life Counseling Center, the person receiving the counseling agrees to release and waive any and all claims of any kind against the ministry, the staff, the staff or lay counselors or the Bread of Life board, which may arise from, result out of, or be related to conduct or advice given.
That all encouragement provided in this ministry is provided in accordance with the biblical principles adhered to by the Georgia Baptist Healthcare Foundation and is not necessarily provided in adherence with any local or national psychological or psychiatric association
That no representation has been made, either expressly or implied, that encouragement, as conducted by the above-mentioned lay counselors, is accepted as customary psychological and/or psychiatric therapy with the definitional terms utilized by those professions.
That the undersigned has read and understands the contents of the waiver, and consent to and requests said encouragement or counseling.
