Freedom Ministries Release & Disclaimer Form

General Information about the form and what happens next....

Freedom Ministries Deliverance Intake and Release & Disclaimer Form
First
Last
I declare that I am emotionally and mentally fit to proceed with deliverance ministry and have fully understood and agree with the above process. I declare that I am a Christian and have accepted Jesus Christ as my Lord and Saviour.
Full Name
Ministry Location:
Have you ever received prayer ministry for your presenting issues?
Have your been receiving prayer ministry regularly throughout your Christian walk?
Name (Most commonly known by)
Maritual Status
Spiritual Information - Salvation / Christian confession:
Date
Family History - Describe your relationship with your parents, stepparents, siblings when you were a child: Biological Father:
Biological Mother:
Siblings:
Stepfather:
Stepmother:
Were you a wanted/planned child?
Were you the sex your parents wanted?
Were you adopted?
Spiritual Evaluation - Occult Practices
If you have participated in any of these practices please tick box.
Spiritual Evaluation - New Age / Psychic Practices
Religious Literature
Religious Beliefs, Cults and or Secret Societies
Physical Health Issues:
Mental Health Profile - If you or family members have this mental health issue please tick the box:
Are you seeing a psychologist?
Are you seeing a psychiatrist?
Emotional Behavioural Profile - Please tick the box that best describes you:
Anger Issues:
Death Issues:
Aberrational Behaviour:
Addictions:
Criminal Activity:
Sexual History (given by permission)
Demonic Activity - Please tick boxes that apply to you:
Demonic Manifestations - please tick the box/s if you have experienced any of the following:
Abnormal Demonic Activities:
First and last name
1. I acknowledge that I understand the above information concerning prayer ministry and deliverance.
2. I acknowledge that I have sought prayer ministry and deliverance of my own free will.
3. I acknowledge that all personal information I reveal is given voluntarily in order to facilitate the healing process.
4. I acknowledge that I release my deliverance ministers from any liabilities and retributions.
5. I acknowledge and I further understand that, if at any time the deliverance minister determines that I require services beyond his or her scope of training they will decline to provide services. If this occurs, the Deliverance Minister may be able to provide a reference to other professionals or agencies. I acknowledge that a referral represents only a suggestion as to where I might obtain assistance, and in no way obligates the Deliverance Minister or the referred professional or agency.
6. I acknowledge and recognise that the outcome of deliverance ministry is dependent upon a number of factors and results cannot be guaranteed.
7. I have read all of the preceding information and understand the purposes of deliverance ministry and am aware of its limited scope of services as well as compliance to Freedom Ministries’ duty of care policies.
8. I am the person named above and have completed this myself.
9. I have read and understand the above conditions of deliverance ministry.
Full Name
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