• Confidential Intake Form

    Deeper Still is a program that conducts biblical healing retreats who have an abortion in their past. This is a confidential Intake Form that is useful for us to know best how to prepare for you and to facilitate a retreat that will meet your needs
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  • Pregnancy History

    History of involvement with pregnancy and abortion if you are a man.
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  •  For your first pregnancy (or the one you were involved in):
    How old were you?
    What was your marital status?    
    Did you feel pressured into the abortion and if so, by whom?
    Were you in favor of the abortion?            
    Do you know the gender of the baby?                      
    Type of abortion if known:          
    What was the outcome of that relationship?      
                 

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  •  For your second pregnancy (or the one you were involved in):
    How old were you?
    What was your marital status?    
    Did you feel pressured into the abortion and if so, by whom?
    Were you in favor of the abortion?            
    Do you know the gender of the baby?                      
    Type of abortion if known:          
    What was the outcome of that relationship?      
                 

    acc.options is not iterable
  •  For your third pregnancy (or the one you were involved in):
    How old were you?
    What was your marital status?    
    Did you feel pressured into the abortion and if so, by whom?
    Were you in favor of the abortion?            
    Do you know the gender of the baby?                      
    Type of abortion if known:          
    What was the outcome of that relationship?      
                 

    acc.options is not iterable
  •  For your fourth pregnancy (or the one you were involved in):
    How old were you?
    What was your marital status?    
    Did you feel pressured into the abortion and if so, by whom?
    Were you in favor of the abortion?            
    Do you know the gender of the baby?                      
    Type of abortion if known:          
    What was the outcome of that relationship?      
                 

    acc.options is not iterable
  •  For your fifth pregnancy (or the one you were involved in):
    How old were you?
    What was your marital status?    
    Did you feel pressured into the abortion and if so, by whom?
    Were you in favor of the abortion?            
    Do you know the gender of the baby?                      
    Type of abortion if known:          
    What was the outcome of that relationship?      
                 

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  • Clear
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  • Are you currently affiliated with any church? if so, what is the name of the church and denomination? Do you believe in the trinity of God? (God the Father, God the Son, God the Holy Spirit?        
    Do you consider yourself a Christian?      If yes, how long have you been a Christian?      If no, what is your religious affiliation, if any?      
      

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  • Clear
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  • Should be Empty: