Oneness Ministries Intake Form

  • Oneness Ministries Intake Form

  • Oneness Ministries Inc. believes God provides His written word for guidance as to what a Spirit-filled life looks like, with the real focus being a relationship with Him.  We believe this is accomplished by grace-filled, Holy Spirit-led counseling, teaching, and life coaching.

    The staff members and group facilitators are not state licensed counselors, partly because the state of Oklahoma does not license biblical counselors, but also because they perform a different function.  We are not "counselors" in the secular sense of the word.  Instead of attempting to counsel individuals as to how they should conduct themselves, we teach understanding of themselves from God's perspective, the character of God, and their relationship with Him.  From this service, changes in thoughts and behaviors naturally flow.  What we offer is Holy Spirit directed ministry, as opposed to secular counseling.

    Our staff does not possess the ability to change your life or fix your problems.  Greater understanding and a different approach to life come through your participation with the Holy Spirit.

    While careful listening and empathy are a part of our process, the type of ministry offered by Oneness is not passive, but directive in nature.  Homework will occasionally be assigned based on the teachings of scripture.  Assignments may include reading, Bible studies, videos, etc.

    Under normal circumstances, everything you discuss will be held in strict confidence.  However, there are some situations where we may be required by law to report information without your permission or knowledge.  These situations include, but may not be limited to:  (1) indication of bodily harm to others, (2) involvement in a felony, (3) suicidal intentions, (4) knowledge of child or elder abuse/neglect.  We might also be required to disclose information in response to a subpoena issued by a court of law.

    Please be considerate and on time for your appointments.  Any cancellations require a 24 hour notice or a full session fee may be charged.  Because we are also a training center, a Oneness Ministries trainee may occasionally participate in the process, with your permission.  Trainees are subject to the same confidentiality guidelines as staff.

    Oneness Ministries is an independent, inter-denominational, non-profit ministry.  We ask all who receive ministry from Oneness Ministries to read and sign this informed consent and to release Oneness Ministries Inc., its agents and employees from any claim whatever arising from the undersigned's participation in Oneness' ministry.

     

  • Date*
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  • Your Financial Responsibility

  • Those who participate financially in the benefits they receive are more successful in achieving their related goals than those who do not participate.  However, we understand that not all clients receiving services have the ability to pay for such services.  Because of our continued desire to not turn anyone away for financial reasons, we want to suggest the following for those clients who truly cannot pay.

    We encourage counselees unable to pay to seek financial sponsorship from family, friends, or their church.  We strongly encourage clients to personally contribute to paying for a portion of their own counseling, even if someone else is sponsoring them.

    Churches can create a Church Sponsorship which would allow them to invest in a new way into the spiritual health and well-being of their church family.  Church Partners can receive a substantial discount on counseling fees.  Please have your church contact us for more information.

    A note about Church Partners:  It is important to understand our confidentiality agreement remains in place unless a limited release form is signed by the client.  Even then, when discussing client progress with a Church Partner, only general information such as whether the client is understanding the information, is applying it to their particular situation, etc. is shared.

  • Counseling/Life Coaching

  • The fee for this service is $50 per 50 minute session.

     

  • Premarital/Marital Counseling

  • The fee for this service is $70 per 50 minute session.

     

  • Initial Appointment

  • The initial intake appointment for either type of service is $50.  During this appointment, staff members may recommend that a client participate in one of the classes or small groups that lay the foundation and/or supplement the counseling services.  We have found they have proven highly effective in helping clients resolve many of the conflicts for which individuals seek counseling.

  • Donations

  • I understand that Oneness Ministries Inc. is a non-profit Oklahoma Corporation.  Oneness operates on donations, which are tax deductible.  Amounts in excess of the counseling fee are tax deductible.

    I have read the above information and understand the financial responsibility of a client receiving services at Oneness Ministries.

    Fees are due when services are rendered.

  • Date*
     - -

  • Disclaimer & Release of Liability

  • I state that I have voluntarily sought assistance on my own initiative and that I am under no obligation to accept or reject any of the information or guidance that I might receive from staff members of Oneness Ministries.

    I agree to hold Oneness and its staff members free from any and all liability, loss or damage of any kind, which may arise as a result of the ministry which I have received, or from my involvement with Oneness Ministries.

    I have read this Informed Consent, Disclaimer and Release of Liability, and understand and agree with it and have executed it as my free and voluntary act.

  • Date*
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  • Oneness Ministries Confidential Intake Form

  • *If you are requestiong couples counseling, BOTH individuals must fill out a separate intake form*

  • Date
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  • Sex
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  • Marital status
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  • Is your spouse currently coming to Oneness (counseling or class)?
  • Have you entered into a relationship with Jesus Christ?
  • How often do you attend:

  • Check Yes or No if this statement describes you most of the time.

  • I prefer to work with things rather than people.
  • I internalize my frustrations with others. I keep it to myself.
  • I'm often critical of myself.
  • People should keep the rules.
  • By the end of the day I feel tired.
  • People frustrate me.
  • I want others to invite me to events.
  • People are too inconsistent.
  • I do not like others inspecting my work/giving advice.
  • I want to know what will happen next.
  • I'm always thinking.
  • I enjoy being alone.
  • I find it difficult to fall asleep immediately.
  • I want lots of information on the outcome before I act.
  • I dislike change.
  • I think of myself as analytical.
  • I want to be in control.
  • I like a challenge.
  • Rules are frustrating.
  • People are lazy.
  • I like others to follow my plan.
  • I have lots of ideas most of the time.
  • I feel circumstances box me in.
  • People need to listen to me more.
  • Others lack the vision to help me accomplish my goals.
  • I prefer being the boss.
  • Problems challenge me.
  • Others often misunderstand me.
  • Others see me as harsh and uncaring.
  • When I get mad everyone knows it.
  • I like to see things happen immediately.
  • I hate routine.
  • I enjoy being with people.
  • I enjoy staying up late when I'm with others.
  • My feelings are easily hurt.
  • Hurting others bother me.
  • I hate routine work.
  • I prefer to work with people and not be left alone.
  • I enjoy social activities.
  • I often feel that others do not like me.
  • I dislike being rejected.
  • I dislike being alone.
  • I like to motivate other people.
  • I cry easily.
  • I enjoy helping other people.
  • I like to include others in my projects.
  • I find myself easily influenced by others.
  • I like belonging to an organization.
  • Check the emotions you experienced: I feel that I am or have been:

  • Check ways you have attempted to fix yourself or your circumstances:

  • Check which of the following describe things you have done or do at your WORST or when you are depressed, angry, etc.

  • Check the characteristics which describe your spouse (or individuals) at their WORST, when you are at your worst. This person(s) is:

  • Should be Empty: