Questionnaire for Scheduling a Consultation

First name

Last name

Email

How did you hear about Healing Judah Wellness?

Why are you interested in working with us?

Are you over the age of 18 right now? We do not see minors at this time.

Yes

No

Are you interested in scheduling these sessions for you? (Interested parties must themselves request services.)

Yes

No

Do you understand this is a coaching service which differs from therapy? (We do not diagnose or provide superbills for insurance reimbursement.)

Yes

No

Do you believe Jesus is the son of God and that He is your Lord and Savior? That He died for the remission of our sins and He rose again in 3 days and is seated at the right-hand side of our Heavenly Father God?

Do you understand that this is a Christian bible based therapeutic coaching service?

Are you comfortable with prayer? (We will typically pray to open/ close sessions.)

What coaching service are you interested in?

Premarital Counseling

Marital Tune Up

Individual coaching with Dr. Kim (women only)

Birth coaching with Dr. Kim

Individual coaching with Don (men only)

Thank you for taking the time to learn more about Healing Judah Wellness and expressing interest by completing this questionnaire. We will review your responses and will reach out to you via email (please ensure it is correct before submitting) for next steps.

Scheduling of consultations are $55 for a 30-minute session.

Fees for services for the package that suits you best will be sent via email and discussed during the consultation.

Please note sessions with not start until this Spring (March 2026).

Questionnaire for Scheduling a Consultation

New Beginnings Await....

Healing Judah Wellness