Inner Healing Intake Form

"I pray that you may prosper in all things and be in health, just as your soul prospers." 3 John 1:2
Please list your first name given at birth and current last name*

First NameLast Name
Nickname or preferred first name if different than birth name

First NameLast Name
Please list your assigned birth gender (male/female). Feel free to share any additional information regarding gender here.*
Due to the sensitive nature of inner healing, typically the leader and prayer partner conducting the session are the same gender as our guest (you). However, there are also times when a husband/wife team may conduct a session. We understand that for whatever reason, you may or may not be comfortable with one of these arrangements. In order to help us facilitate a respectful, healing environment, please state any personal preferences you may have regarding your session.*
Email (we will email you pre-session instructions and a copy of your session recording/notes afterwards)*
example@example.com
Phone Number (a session leader will call you to schedule an appointment - please be patient as this may take a few days due to our limited volunteer staff)*
Please enter a valid phone number.
What time zone are you in?*

Pacific (PST)Mountain (MST)Central (CST)Eastern (EST)
Please list any food or essential oil allergies you may have.*
During our in-person sessions, we diffuse essential oils and provide refreshments
Session Location Preference*

In person (in Sandpoint, Idaho)Zoom (unable to come to Sandpoint)I would prefer not to meet in a church building, if possible.
Briefly describe your prayer need.*
Do you have a personal relationship with Jesus Christ as your Lord and Savior?*
Have you ever experienced any kind of inner healing or deliverance ministry before this? If so, was your experience a positive or negative one? Please explain.*
A session usually lasts between 1.5 - 3 HOURS.

With the above timeframe in mind, please select a few options below that would work best for you for that length of time (1.5 - 3 HOURS).

Please keep in mind... we will do our best to accomodate your preference, but all of our prayer ministers are volunteers who may or may not be available during your requested times.
Please select your preferred availablity below:*

Weekday morningsWeekday afternoonsWeekday eveningsSaturday morningsSaturday afternoonsSaturday eveningsSunday afternoons
We don't usually provide childcare during a session, but if you absolutely don't have access to any childcare and need help with your children during a session, please briefly describe your situation: How many children? What are their ages? Do they have any special needs, etc.?
How did you hear about us? If someone referred you, please let us know so we can thank them!*
All our staff and volunteers, while not professionally licensed, are called to this work, have personally experienced inner healing, and have undergone extensive training. Our deepest desire is to help every person who comes through our doors encounter God's love in a transformational way. Of course, we expect everyone to have a wonderful, healing experience. However, due to the nature of the world we live in, we ask that you read and agree to the following terms before entering a session. Thank you for your understanding!

I, the undersigned, do hereby release HVWC, their volunteers and/or staff from any and all liability, for any harm or percieved harm resulting from my voluntary receiving of free prayer ministry on this and subsequent visits.

I understand that these sessions are staffed by volunteers representing the body of Christ and reflecting the biblical beliefs and teachings of HVWC. I understand they are not trained or licensed professionals of counseling, therapy, medical or any other related services.

I understand that if I am currently taking medications or operating under the advice of a professional care provider, I will allow them (my medical doctor, therapist, counselor, etc.) to confirm any results of prayer received before altering any prescribed course of treatment.

I understand that this form and all data recorded on it and/or within a healing session is the sole property of HVWC. All content will be held in utmost confidence for the sole purpose of my individual healing.
Insert digital signature below by typing your full name:*
Although these sessions are free of charge, this ministry cannot operate without the generous contributions of people like you.

Every $1 counts! No amount is too small. Donations help provide necessary training materials for our team, session supplies, other operational expenses, and they help offset costs to outside resources for those in need of medical and/or mental health services that are beyond our scope.

Also, a portion of every $1 given, goes toward supporting anti-trafficking efforts in the Pacific Northwest.

We are sincerely grateful for every donation, no matter how big or small!
Specify desired amount here. After you click "submit" below, you'll recieve a donation link. THANK YOU!*

$5$10$15$25$50$100I would like to make a larger donation than listed aboveI am unable to make a donation at this time
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"I pray that you may prosper in all things and be in health, just as your soul prospers." 3 John 1:2