get counseling through axis church

The Axis Church believes in the power of talking to others and accepting help. Our Axis Ministry Partners are offered s discount through Lantern Lane Counseling. If you are in need of counseling, please fill out the form below.

Axis Request for Counseling 2

Name

First Name

Last Name

Parent/Guardian Name if under 18

First Name

Last Name

Date

MM

DD

YYYY

Email

Phone

(###)

###

####

Gender

Male

Female

Age Range

Adult

Teen

Child

Are you an Axis Ministry Partner?

Yes

No

Are there any notes you'd like to add?