Application to Work With Jamal Jones

Licensed Marriage & Family Therapist I Relationship Legacy Consultant

Thank you for your interest in working with us.

Jamal helps individuals, couples, families, leaders, entrepreneurs, pastors, nonprofit organizations, and teams gain clarity, strengthen relationships, improve leadership effectiveness, and create lasting impact.

Depending on your goals and circumstances, support may include counseling, relationship legacy consulting, leadership development, fundraising consultation, speaking, training, or educational community support.

Please complete this application thoughtfully so we can determine the most appropriate next step.

Your information will be sent to us automatically, and you'll receive an email with your next steps. If you have any questions, feel free to reach out at [email protected]. We look forward to connecting with you!

Full Name *

Phone

*By providing your phone number, you agree to receive text messages from Central Valley Christian Counsel regarding appointments, services, and updates. Message frequency varies. Message and data rates may apply. Reply STOP to opt out.

Email *

Central Valley Christian Counsel is a private-pay counseling practice and does not accept insurance. *

I am specifically seeking private-pay counseling

I understand insurance is not accepted and I am comfortable proceeding

I am looking for insurance-based services

Are you currently experiencing a mental health crisis requiring immediate medical care? *

Yes

What type of support are you interested in exploring? (Select all that apply) *

Individual Counseling

Couple / Marriage Counseling

Family Counseling

Relationship Legacy Consulting

Leadership Development Consulting

Fundraising & Nonprofit Consulting

Speaking or Training

Not sure Yet

Which best describes you? *

Individual

Married Individual

Couple

Family

Entreprenuer

Business Owner

Executive or Leader

Pastor or Ministry Leader

Nonprofit Leader

Organization Seeking Counseling

Other

What is your spouse/partner's full name?

What challenges are you seeking help solving? *

Anxiety, stress or emotional overwhelm

Marriage or relationship concerns

Family Challenges

Leadership Development

Team or organizational challenges

Fundraising or nonprofit development

Business or entreprenuerial challenges

Faith, purpose, and calling

Communication and conflict resolution

Personal Growth and development

Other

Pleae briefly describe your situation and whath prompted you to reach out today. Please provide enough detail to help us understand your current situation, concerns, goals, and what led you to seek support at this time.

Why is now the right time to seek support? What changed recently, and why is addressing this important to you now? *

If our work together is successful, what would be different six months from now? Please describe the outcomes, changes, or results you hope to achieve in your life, relationships, leadership, business, ministry or organization. *

What responsibility are you willing to take in creating the change you desire? Meaingful change often requires intentional effort, honesty, and action. Please share how you are prepared to participate in the process. *

We believe the right support can be a life-long changing investment. The following question helps us determine the most appropriate counseling, consulting, coaching, educational, or community support options for your current situation.

Which statement best describes your current situation? *

I am prepared to invest in private-pay counseling, consulting, or coaching services if we determine we are a strong fit.

I would prefer to use insurance benefits

I am primarily seeking lower-cost support options.

I am not sure yet

If we determine we are a strong fit, how soon would you ideally like to begin?

Immediately

Within 30 Days

Within 90 Days

Just Exploring Options

Who will ultimately decide whether you move forward with counseling, consulting, coaching, or leadership support?

I will make the decision myself

My spouse/partner and I will decide together

My organization or leadership team will decide

Someone else must approve my decision

What have you already tried to address this challenge or achieve this goal? *

Why is it important to you to address this now rather than later? *

Consent Checkbox

By checking this box, I consent to receive SMS messages from Central Valley Christian Counseling regarding appointment scheduling, appointment reminders, responses to inquiries, and other service-related communications. Message frequency may vary. Message and data rates may apply. Reply STOP to opt out or HELP for help.

By checking this box, I consent to receive marketing and informational SMS messages from Central Valley Christian Counseling, including wellness tips, service updates, event announcements, and special offers. Message frequency may vary. Message and data rates may apply. Reply STOP to opt out or HELP for help.