New Reflections Counseling, Inc.
Professional Christian Counseling
937-776-7290
If you have any questions you may call one of the numbers or use our
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. All correspondence is held in strict confidence.
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Dayton - Montgomery County - Centerville
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When you contact NRC we will attempt to respond within 4 business hours. However, we might need until the next business day. Filling out this contact form will speed up the process of us contacting you and scheduling an appointment.
All correspondence is held in strict confidence for internal use only (not sold, traded, or given away).
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Appointment Preferences
Reason for Scheduling (primary reason):
<- Select One ->
Spiritual > Growth (closer to God)
Spiritual > Condemnation (guilt, fear of hell)
Spiritual > Faith (belief, crisis, trust)
Spiritual > Purpose (meaning, calling, gifting)
Spiritual > Attack (demonic, satan)
Spiritual > Spiritual (other)
Personal > Abuse: Emotional (verbal, spiritual)
Personal > Abuse: Physical (violence)
Personal > Abuse: Sexual (incest, molestation)
Personal > Abuse: Sexual (rape, date-rape)
Personal > Addiction: Eating Disorder (food)
Personal > Addiction: Electronic (video, computer, internet)
Personal > Addiction: Sexual (pornography, sex, fetish)
Personal > Addiction: Substance (drugs, alcohol)
Personal > Addiction: Other
Personal > Adjusting to Loss: Abortion
Personal > Adjusting to Loss: Break Up (dating, relationship)
Personal > Adjusting to Loss: Infertility
Personal > Adjusting to Loss: Death
Personal > Adjusting to Loss: Divorce
Personal > Adjusting to Loss: Miscarriage
Personal > Adjusting to Loss: Other
Personal > Adjusting to Getting Older
Personal > Adjusting to Moving (culture, shock, deployment)
Personal > Anger (self-control, temper, guilt)
Personal > Anxiety (fear, worry)
Personal > Anxiety (panic attacks, nightmares, flashbacks)
Personal > Anxiety: PTSD (post-traumatic-stress-disorder)
Personal > Anxiety: DID (dissociative-identity-disorder)
Personal > Anxiety: OCD (obsessive-compulsive-disorder)
Personal > Boundaries (setting limits, people-pleasing)
Personal > Depression
Personal > Depression: Loneliness (isolated, disconnected)
Personal > Depression: Suicidal
Personal > Forgiveness (self, bitterness)
Personal > Goals (life-coaching, plan, transition, manage change)
Personal > Growth: Emotional
Personal > Healing Emotional Wounds
Personal > Honesty (stop lying)
Personal > Identity (knowing self, contentment, self-acceptance)
Personal > Identity: Manhood (be a better man, husband, father)
Personal > Identity: Womanhood (be a better woman, wife, mother)
Personal > Mental Illness (diagnosis, medication, psychosis)
Personal > Mood Swings (irritability, sensitivity)
Personal > Neglect (abandonment, childhood wounds)
Personal > Numbness (cannot feel, empty, isolated, disconnected)
Personal > Self-Harm (cutting, burning, mutilation)
Personal > Self-Worth (low self-esteem, insecurity, shame, self-hatred)
Personal > Sexuality (unwanted thoughts or behaviors)
Personal > Singleness Issues
Personal > Stress (overwhelmed, management)
Personal > Work: Career Choices
Personal > Work: Job Loss
Personal > Coping with People (their problem, dysfunction, sin)
Personal > Trauma (other)
Personal > Personal (other)
Relational > Dating
Relational > Dating: Get Married or Break Up?
Relational > Dating: Pre-marital (pre-engagement)
Relational > Boundaries (separation, safety)
Relational > Boundaries (between couple and other people or things)
Relational > Conflict Resolution
Relational > Communication
Relational > Intimacy: Emotional (interest, pursuing, engaging)
Relational > Intimacy: Sexual (passion, love-making)
Relational > Intimacy: Time (doing, companionship, playing)
Relational > Betrayal (affair, dishonesty, cheating, infidelity, unfaithful)
Relational > Trust Issues
Relational > Reconciliation (repentence, forgiveness, negotiation)
Relational > Divorce
Relational > Remarriage
Relational > Workplace (boss, coworkers, employer, employee)
Relational > Family (adult conflict)
Relational > Family (child maturity)
Relational > Family (parenting)
Relational > Relational (other)
Reason for Scheduling (second reason):
<- Select One ->
Spiritual > Growth (closer to God)
Spiritual > Condemnation (guilt, fear of hell)
Spiritual > Faith (belief, crisis, trust)
Spiritual > Purpose (meaning, calling, gifting)
Spiritual > Attack (demonic, satan)
Spiritual > Spiritual (other)
Personal > Abuse: Emotional (verbal, spiritual)
Personal > Abuse: Physical (violence)
Personal > Abuse: Sexual (incest, molestation)
Personal > Abuse: Sexual (rape, date-rape)
Personal > Addiction: Eating Disorder (food)
Personal > Addiction: Electronic (video, computer, internet)
Personal > Addiction: Sexual (pornography, sex, fetish)
Personal > Addiction: Substance (drugs, alcohol)
Personal > Addiction: Other
Personal > Adjusting to Loss: Abortion
Personal > Adjusting to Loss: Break Up (dating, relationship)
Personal > Adjusting to Loss: Infertility
Personal > Adjusting to Loss: Death
Personal > Adjusting to Loss: Divorce
Personal > Adjusting to Loss: Miscarriage
Personal > Adjusting to Loss: Other
Personal > Adjusting to Getting Older
Personal > Adjusting to Moving (culture, shock, deployment)
Personal > Anger (self-control, temper, guilt)
Personal > Anxiety (fear, worry)
Personal > Anxiety (panic attacks, nightmares, flashbacks)
Personal > Anxiety: PTSD (post-traumatic-stress-disorder)
Personal > Anxiety: DID (dissociative-identity-disorder)
Personal > Anxiety: OCD (obsessive-compulsive-disorder)
Personal > Boundaries (setting limits, people-pleasing)
Personal > Depression
Personal > Depression: Loneliness (isolated, disconnected)
Personal > Depression: Suicidal
Personal > Forgiveness (self, bitterness)
Personal > Goals (life-coaching, plan, transition, manage change)
Personal > Growth: Emotional
Personal > Healing Emotional Wounds
Personal > Honesty (stop lying)
Personal > Identity (knowing self, contentment, self-acceptance)
Personal > Identity: Manhood (be a better man, husband, father)
Personal > Identity: Womanhood (be a better woman, wife, mother)
Personal > Mental Illness (diagnosis, medication, psychosis)
Personal > Mood Swings (irritability, sensitivity)
Personal > Neglect (abandonment, childhood wounds)
Personal > Numbness (cannot feel, empty, isolated, disconnected)
Personal > Self-Harm (cutting, burning, mutilation)
Personal > Self-Worth (low self-esteem, insecurity, shame, self-hatred)
Personal > Sexuality (unwanted thoughts or behaviors)
Personal > Singleness Issues
Personal > Stress (overwhelmed, management)
Personal > Work: Career Choices
Personal > Work: Job Loss
Personal > Coping with People (their problem, dysfunction, sin)
Personal > Trauma (other)
Personal > Personal (other)
Relational > Dating
Relational > Dating: Get Married or Break Up?
Relational > Dating: Pre-marital (pre-engagement)
Relational > Boundaries (separation, safety)
Relational > Boundaries (between couple and other people or things)
Relational > Conflict Resolution
Relational > Communication
Relational > Intimacy: Emotional (interest, pursuing, engaging)
Relational > Intimacy: Sexual (passion, love-making)
Relational > Intimacy: Time (doing, companionship, playing)
Relational > Betrayal (affair, dishonesty, cheating, infidelity, unfaithful)
Relational > Trust Issues
Relational > Reconciliation (repentence, forgiveness, negotiation)
Relational > Divorce
Relational > Remarriage
Relational > Workplace (boss, coworkers, employer, employee)
Relational > Family (adult conflict)
Relational > Family (child maturity)
Relational > Family (parenting)
Relational > Relational (other)
Reason for Scheduling (third reason):
<- Select One ->
Spiritual > Growth (closer to God)
Spiritual > Condemnation (guilt, fear of hell)
Spiritual > Faith (belief, crisis, trust)
Spiritual > Purpose (meaning, calling, gifting)
Spiritual > Attack (demonic, satan)
Spiritual > Spiritual (other)
Personal > Abuse: Emotional (verbal, spiritual)
Personal > Abuse: Physical (violence)
Personal > Abuse: Sexual (incest, molestation)
Personal > Abuse: Sexual (rape, date-rape)
Personal > Addiction: Eating Disorder (food)
Personal > Addiction: Electronic (video, computer, internet)
Personal > Addiction: Sexual (pornography, sex, fetish)
Personal > Addiction: Substance (drugs, alcohol)
Personal > Addiction: Other
Personal > Adjusting to Loss: Abortion
Personal > Adjusting to Loss: Break Up (dating, relationship)
Personal > Adjusting to Loss: Infertility
Personal > Adjusting to Loss: Death
Personal > Adjusting to Loss: Divorce
Personal > Adjusting to Loss: Miscarriage
Personal > Adjusting to Loss: Other
Personal > Adjusting to Getting Older
Personal > Adjusting to Moving (culture, shock, deployment)
Personal > Anger (self-control, temper, guilt)
Personal > Anxiety (fear, worry)
Personal > Anxiety (panic attacks, nightmares, flashbacks)
Personal > Anxiety: PTSD (post-traumatic-stress-disorder)
Personal > Anxiety: DID (dissociative-identity-disorder)
Personal > Anxiety: OCD (obsessive-compulsive-disorder)
Personal > Boundaries (setting limits, people-pleasing)
Personal > Depression
Personal > Depression: Loneliness (isolated, disconnected)
Personal > Depression: Suicidal
Personal > Forgiveness (self, bitterness)
Personal > Goals (life-coaching, plan, transition, manage change)
Personal > Growth: Emotional
Personal > Healing Emotional Wounds
Personal > Honesty (stop lying)
Personal > Identity (knowing self, contentment, self-acceptance)
Personal > Identity: Manhood (be a better man, husband, father)
Personal > Identity: Womanhood (be a better woman, wife, mother)
Personal > Mental Illness (diagnosis, medication, psychosis)
Personal > Mood Swings (irritability, sensitivity)
Personal > Neglect (abandonment, childhood wounds)
Personal > Numbness (cannot feel, empty, isolated, disconnected)
Personal > Self-Harm (cutting, burning, mutilation)
Personal > Self-Worth (low self-esteem, insecurity, shame, self-hatred)
Personal > Sexuality (unwanted thoughts or behaviors)
Personal > Singleness Issues
Personal > Stress (overwhelmed, management)
Personal > Work: Career Choices
Personal > Work: Job Loss
Personal > Coping with People (their problem, dysfunction, sin)
Personal > Trauma (other)
Personal > Personal (other)
Relational > Dating
Relational > Dating: Get Married or Break Up?
Relational > Dating: Pre-marital (pre-engagement)
Relational > Boundaries (separation, safety)
Relational > Boundaries (between couple and other people or things)
Relational > Conflict Resolution
Relational > Communication
Relational > Intimacy: Emotional (interest, pursuing, engaging)
Relational > Intimacy: Sexual (passion, love-making)
Relational > Intimacy: Time (doing, companionship, playing)
Relational > Betrayal (affair, dishonesty, cheating, infidelity, unfaithful)
Relational > Trust Issues
Relational > Reconciliation (repentence, forgiveness, negotiation)
Relational > Divorce
Relational > Remarriage
Relational > Workplace (boss, coworkers, employer, employee)
Relational > Family (adult conflict)
Relational > Family (child maturity)
Relational > Family (parenting)
Relational > Relational (other)
Reason for Scheduling (not listed above):
Counseling Format:
Individual?
Relationship?
Pre-Engagement?
Pre-Marital?
Marriage?
Family?
Group?
Counseling Location/Method:
Face-to-Face Dayton (Centerville)?
Video?
Phone?
Chat?
Email?
No Preference?
Day of Week Availability:
Monday?
Tuesday?
Wednesday?
Thurday?
Friday?
Saturday?
No Preference?
Time of Day Availability:
Morning (8am-12pm)?
Afternoon (12pm-5pm)?
Evening (5pm-9pm)?
No Preference?
Counselor's Gender:
Male?
Female?
No Preference?
Counselor(s) You Prefer To See:
Appointment Date/Time First Choice:
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Appointment Date/Time Second Choice:
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Appointment Date/Time Third Choice:
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After you click Submit Contact, we will send you a confirmation email from our Contact email. We don't regularly monitor this email, so please use this form to contact us. Or, you can use your counselor's direct email.
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New Reflections Counseling, Inc.
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