Inner Healing Session

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Gender*

MaleFemale

Age (Must be 18 or older)*

Appointment Type: Do you prefer to meet in person or remote? (All in person meeting will be at Beach Chapel, 510 S. El Camino Real, Encinitas, CA 92024, remote meetings will be held via Zoom)*

In PersonRemote

Briefly describe why you are seeking help:*

Are you currently under the care of a psychiatrist, psychologist, therapist, or licensed counselor?*

Have you been through inner healing or deliverance ministry?*

YesNo

If yes: when, with whom, and what was the context of your last session?

How did you hear about Father's Heart Ministry?*

Internet/Social MediaFamily/FriendOther

Liability Release Form

 The purpose of this ministry is for spiritual growth and healing. It is not a psychological counseling service, nor is it intended to be. Team members are not licensed psychologists or psychiatrists; however, they are trained in using the Word of God and prayer through the power of the Holy Spirit. The results of this approach depend on the willingness of the individual to make wise choices consistent with the teachings of Jesus Christ. Recommendations for further counseling with outside therapists/practioners may be made after initial appointments if deemed appropriate.  

All personal information gathered in the course of a ministry session is confidential, and the files are so maintained. Discipleship, the commitment to train others in the mastery of ministry skills, is an ongoing aspect of this ministry. Qualified disciples may be assigned during ministry sessions. The adherence to a strict policy of confidentiality includes disciples working with prayer ministers. 

Father’s Heart Ministry will abide by all laws regarding the reporting of threats to self, threats to others, abuse of a child, abuse of the elderly and/or other behavior deemed by Father’s Heart Ministry to be harmful to yourself or others. Regardless of local laws, and out of care and respect for God's creation, Father’s Heart Ministry will report any of the above to the proper authorities. 

Father’s Heart Ministry will leverage technology including, but not limited to, Zoom and other video conferencing platforms. Father’s Heart Ministry is neither responsible nor liable for the use of this technology or any issues related to the privacy and security of such technology. None of the participants will record any session unless all participants agree to the same.

 I understand the above information concerning this ministry. I have sought this ministry of my own free will and am under no obligation to accept or reject any of the advice or help that I might receive from the team members of this ministry. All personal information I reveal is given voluntarily in order to facilitate the team members working with me. I further release Father’s Heart Ministry from any and all liability, loss, or damage of any kind that may arise or result from these ministry sessions.

 Please populate the fields below to acknowledge that you have read the Liability Release Form and that you acknowledge and accept the guidelines stated above.  

The fee for one session is $200. Each session lasts approximately 2 hours.

By typing your name you agree to the liability release:*

First NameLast Name

Once we receive the application we will send a link to schedule your session. We are looking forward to meeting with you!