Desert Deliverance
Intake Questionnaire
Please fill in the blanks or check the boxes for any items that apply to you, then click the SUBMIT button when finished.
(Red asterisk ✳ indicates required response)
Name *
E-mail *
Cell
Phone
Preferred Method(s) of Communication (E-mail/Texts/Phone)
 *
How did you hear about Desert Deliverance? *
How familiar are you with deliverance ministry? Watched any videos? Who's? *
Are you currently attending church services on a regular basis? *
If yes, what denomination? *
Have you received deliverance prayer before? If yes, did you feel free? *
Briefly, what is going on in your life that has brought you here today? *
Are you involved in ongoing secular (non-religious) counseling or therapy? If yes, please explain. *
 *