Freedom 360º Ministry Request Form

Your Name*

First NameLast Name

Address (USA Only)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Country (If Outside USA)

Phone Number (USA Only)

Area CodePhone Number

E-mail*

Gender*

MaleFemale

Age*

Must be 18 years or older. If under 18, please contact us directly.

How did you hear about us?*

I have attended one of your eventsI was referred by a friendWebsiteOther

Current Profession?*

Have you ever received inner healing or deliverance ministry before?*

If yes, how long ago?*

RecentlyA few monthsA few years agoDo not remember

Did you experience a change in your life after your ministry session?*

YesNo

Were there been any changes in your life which affected you emotionally? Please Explain.

How often do you attend church?*

Are you active in your church or ministry? Explain:*

When you accepted Christ as your Savior and Lord, did your life recognizably changed?*

YesNo

Have you been water baptized as a born-again believer?*

YesNo

In one sentence, describe who Jesus Christ is to you?*

Is regular repentance part of your Christian life?*

YesNo

Do you pray daily?*

YesNo

Describe your prayer life*

Rich and fulfillingEnjoyable but could be betterDifficultI never pray

How often do you read the Bible?*

DailySeveral times weeklyOccasionallyAlmost never

Are you hindered in your prayer life or Bible reading?*

YesNo

If yes, Explain:

Are you assured that you're going to heaven?*

YesNo

Do you ever fear loosing your salvation?*

YesNo

Do you believe and feel that God loves you?*

YesNoOther

Do you have a problem with doubt and/or unbelief in everyday Christian living?*

YesNo

If so, briefly explain:

Have you been baptized in the Holy Spirit?*

YesNoNot sure

Do you speak in tongues?*

YesNoNot sure

Are you satisfied with your Christian walk?*

YesNo

If not, how would you like it to change?

What specific areas are you seeking breakthrough in?*

How long have you been dealing with the condition you are seeking healing/freedom from?*

Have you sought medical help for this condition?*

YesNo

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

YesNo

Do you know the diagnosis?

Are you in agreement with receiving Freedom 360º Ministry from Global NEST Ministries?*

YesNo

Ministry is done Monday nights. Are you available?*

YesNoOther

YOU WILL RECEIVE A SEPARATE QUESTIONNARE FOR YOU TO FILL OUT AND A RELEASE FORM TO SIGN. ONCE THOSE FORMS ARE SUBMITTED TO US, WE WILL CONTACT YOU WITH AN APPOINTMENT DATE.

THANK YOU!

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 psychologist or psychiatrist; 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 .

All personal information gathered in the course of a ministry session is confidential, and the files are so maintained, however, information, as needed, may be shared with the leaders of Global NEST.

I understand the above information concerning this ministry. I have sought this ministry of my own free will and I am under no obligation to accept or reject any of the advice or help that I may 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 Global NEST ministries from any and all liability, loss or damage of any kind they may arise a result from this ministry sessions.

Please sign your name on the field below to acknowledge that you have read and understand this liability release form.

Signature. (You can use your mouse on a computer or your finger on any smart device)*

Freedom 360º Ministry Request Form

Liability Release Form