Counseling Referral

If you're looking for a Christian counselor, please complete this confidential form and a professionally trained staff member will contact you shortly to help you locate one.

First Name *
Last Name
Phone Number
Email *
Attend Fairfax Community Church services regularly? *
Currently a member of an FCC small group? *
If you have insurance, does it cover mental health?
Please select the issue that best applies... *
If you're comfortable, please give us more detail on the issue(s) you are facing.

Fairfax Community Church • 11451 Braddock Road • Fairfax, VA 22030
(703) 745-1030 • Fax: (703) 745-1069 • © Fairfax Community Church
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