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counselling request
90 Bethlehem Rd, Bethlehem, Tauranga
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You can contact us via our detailed form below, or directly at bbc@bethlehem.org.nz

Please enter your info and select all that apply

  • Counselling Request

  • What type of counselling are you looking for?

  • What is your gender?

  • When were you born?

  • Date Format: MM slash DD slash YYYY

  • Do you consider yourself to be religious?

  • Do you consider yourself to be spiritual?

  • What is your relationship status?

  • Have you ever been in counselling or therapy before?

  • How would you rate your current physical health?

  • How would you rate your current sleeping habits?

  • How would you rate your current eating habits?

  • How would you rate your current financial status?

  • Please include any other information you would like to share

contact us

P | 07 576 2344
E | info@placeofhope.nz
A | 90 Bethlehem Rd, Bethlehem, Tauranga

www.bethlehem.org.nz
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