SOZO Request

SOZO Request
Date

MonthDayYear
Date
Name

First NameLast Name
E-mail
Phone
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Male/Female

MaleFemale
Birthdate
(If you are under 18 a consenting parent/guardian needs to sign this form before your SOZO session.)
Name of consenting parent/guardian
Relationship to you
Have you had prior SOZO sessions:

None1st request2nd request3rd requestMore
Presently attend church at:
Church city and state:
Date and time of day you are available for your SOZO appointment

MonthDayYear
DateHourMinutesAM/PM Option
SOZO method you are comfortable with:

In personPhoneSkypeFacetime
My needs for ministry concern: (Check all that apply)

Emotional issuesInner HealingPhysical HealingDeliveranceOther (explain)Other
Please check all that apply:

Currently taking anti-anxiety medicationCurrently grieving the loss of a significant relationship, job, etc.
Have you accepted Jesus as your Savior and Lord?

YesNoDon't know
If Yes, approximate date/place where you accepted Jesus as Savior
Were you water baptized AFTER accepting Jesus?

YesNoDon't know
Have you been baptized in the Holy Spirit?

YesNoDon't know
Completion of this form automatically adds you to the waiting list. A copy of this confidential form will be given to SOZO leaders/ministry staff for purposes of prayer and session preparation. We need you to confirm that you agree with this procedure.
I understand and agree to the above statement regarding who will be given a copy of this confidential form:

YesNo
Please note: This ministry does not provide home visitation, crisis ministry, personal or family intervention.
Release of Liability

By checking the box below, I do hereby release staff, leaders and volunteers, from any harm or perceived harm resulting from my voluntary receiving of free prayer on this and subsequent visits.

I understand that this ministry is provided by a volunteer staff representing the body of Jesus Christ. They are not trained, licensed medical professionals; psychological counselors; or therapists. They do not provide medical or psychological services.
I understand and agree to the Release of Liability Statement

YesNo
By checking the box below, I acknowledge that I need to seek advice from my medical doctor/therapist/counselor/any other professionals to confirm any results of prayer received before altering any prescribed course of action.
I understand and agree to the above statement regarding seeking advice:

YesNo
By checking the box below, I understand this ministry is free. The SOZO team will minister to you whether you give or not. However, we do ask that you pray about making a donation to help in the development and growth of the ministry.

Make checks payable to TALL Truth and mark “SOZO” in the memo area. You can also donate cash or use a credit card on the TALL Truth website, wwwshellydonahue.net, under the donate tab. Please completely fill out information including name, address, and phone.
I realize this ministry is free; however, a donation is appreciated.

YesNo
SOZO Applicant Signature

Clear
Date signed
(If you are under the age of 18, this form must also be signed below by a parent or guardian.)
Parent of Legal Guardian Name
Signature of Parent or Legal Guardian

Clear
Witnessed by SOZO Leader

Clear
Date
TALL Truth is a 501(c)(3) prayer and donor-supported ministry.

Your financial contribution is tax deductible.

TALL Truth

1330 5th St. Eaton, CO 80615

www.shellydonahue.net

720 935 1617
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