Clone of HeartCare Agreement & Intake Form

HeartCare Application Form
HeartCare is a safe, guided space for deep heart work with Jesus — and it’s important that it’s the right fit for both of us. This short application helps me understand your season, your hopes, and which format would suit you best. It also means I can make sure I have space to give you the care and attention you deserve. Once you’ve filled in the application below, I’ll be in touch to let you know if I can offer you a place and guide you through the next steps.
Client Details
Name*

First NameLast Name
Email*
example@example.com
Location*
HeartCare Pathway
Which format would you like to join HeartCare Foundations?*

Group In-PersonGroup Online (I want to be placed in a group)Group Online (I already have a group)Solo OnlineI'm unsure/other
Name of Group Host (if you have one)
Group Code (if you have one)
How did you find HeartCare?*
What's drawing you to participate in HeartCare right now?*
This helps us understand what you’re looking for, so I can support you well.
How would you describe your current emotional/spiritual health?*
This helps us know if you already have extra professional support.
Other:
Have you done any of the following?*

Inner healing prayer ministry (Eg. Sozo, Elijah House etc)Emotional health coaching/programCounsellingPsychologistPsychiatristOther
Other:
Would you like to be added to the Rise Project Co. mailing list?*

Yes pleaseNo thanks
Should be Empty:

HeartCare Application Form