Desert Deliverance
Intake Form

 

(Everything we do is one-on-one, we do not do group deliverance)

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)

First Name *
Last Name *
E-mail *

Are you familiar with Zoom video conferencing?

 *
How did you hear about us? If you found us on a search engine, what exactly were you searching for? (i.e. online deliverance, deliverance ministry, etc)? *
How familiar are you with deliverance ministry? Have you watched any videos? If yes, who's videos? *
Have you received deliverance prayer before? If yes, how many times? Did you feel free? *
Are you currently attending church services on a regular basis? If no, please explain. *
If yes, what denomination? *

Have you had any of the following? Please select all that apply.

 *

Do you have a relationship with mature Christian friends, or a small group that can help you continue to grow after receiving ministry?

 *
Briefly, what is going on in your life that has brought you here today? *

What would you like to focus on during your time with us? (check all that apply)

 *
If you answered "Other" in the above question, please explain.
Are you involved in ongoing secular (non-religious) counseling or therapy? If yes, please explain. *
If you answered yes to the above question, please list the names of any disorders you are currently being prescribed medication for.

Are you currently receiving ministry from a healing/deliverance minister, or your pastor?

 *

Please select the option that best applies to you.

 *

Please select the option that best applies to you.

 *
Please add any additional comments that you feel may be helpful.