F.A.R. Intake Form

F.A.R. Intake Form

This session is not informational, it is transformational. Please answer honestly before YAHUAH. Your responses will help us facilitate this experience with wisdom, order, and care.
Contact and Attendance
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Forgiveness and Belief
Are you willing to forgive, even if you don’t feel ready?*
Do you believe reconciliation is always required?*
Forgiveness Story
Who or what are you struggling to forgive?*
How long have you been carrying this?*
AngerSadnessFearShameGuiltNumbnessResentmentBetrayalOther
Have you tried to forgive before?*
What made it difficult to maintain?
Relationship Context
Is the person still in your life?*
Current relationship status*
Do you desire reconciliation (if safe and righteous)?*
Safety and Support
Emotional abusePhysical abuseSexual abuseSpiritual/religious abuseNeglectBetrayal/InfidelitySlander/LibelOther serious harm
Would you prefer private support if needed?*
Faith, Freedom, and Follow-Up
What are you believing YAHUAH to do; what are your expectations?*
I am willing to release offense and walk in obedience
Testimony Option*
Follow-Up*
Should be Empty: