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Confidential Ministry Questionnaire

Steps in your journey with Operation Light Force "Healing for Today" Ministry
Thank you for considering Operation Light Force to come along side you in your journey to wholeness and freedom in Christ. Our desire is for you to be a disciple that is able to think, act, and be like Jesus. 1. You are already taking the first step by filling out this intake form and making sure it gets back to us. 2. After you have filled out the intake form, you will be given the opportunity to meet with a coordinator to determine where the best placement for you will be to begin your journey with us.

Description of Personal Prayer Ministry
Personal Prayer Ministry is a blended approach to Christian ministry for individuals of all backgrounds who are seeking focused spiritual help to overcome life’s hurts, in a gentle, compassionate manner. Ministry areas include discussion and healing prayer into the foundational areas of one’s life: generational/family of origin issues, core beliefs, emotional wounding and release from oppression, dealing with personal sins and addictions. During your prayer ministry session, you will be given an opportunity to discuss issues in your life that you feel are hindering you from truly walking in God’s love. Our prayer ministers will be praying with you in detail with the knowledge and faith resulting from their own experiences of emotional, physical and spiritual healing as well as keys God has given to reveal and bring healing to the areas in your life that need reconciling to God. The number of sessions varies, depending on the situation. We begin with 4 sessions and after your fourth session we will reassess your needs and the effectiveness of your ministry time. At that time we may change the plan. You may be moved to sessions every other week, or to a group or whatever we think will bring you freedom. Each ministry session usually lasts 1 and a half to 2 hours, although this may vary according to the needs and schedule of an individual. Information will be treated confidentially. While our desire is to be as warm and personal as possible, we do need to satisfy certain legal requirements by addressing certain waivers. So please read the entire intake form, and if you find it satisfactory, please complete and sign it, indicating that you understand and agree to the conditions.

Expectations of Your Commitment
We will be making a major commitment to you, as we schedule our time to be available to you, and as we pray, prepare, and then minister to you, It is expected that you will be committed to obtaining the maximum benefit possible from your ministry time. You can facilitate this by being on time and by completing any assignments. We ask that you commit to appointments and notify us at least one day in advance if you can not make your appointment. Please respond to the email invitations as soon as possible to help us know who will or will not be coming and to help our prayer ministers not make the trip for nothing. Most of all, it is expected that you will have a sincere desire to overcome whatever difficulties you are struggling with. Regular contemplative prayer and Bible reading will also facilitate this process. The more you can hear from God for yourself and participate in your healing by taking responsibility as you learn the more you will see results.

* First Name:
 * Last Name:
* Address:
* City:
 * State / Province
 * Zip Code:
* Phone:
 * Email:
Personal Information
* Date of Birth
* Age
* Marital Status
Single
Married
Separated
Divorced
Widowed
Remarried
* Gender
Male
Female
Presently Living With
Parents
Spouse
Alone
Other
* Occupation
* Hours worked/week
* Employed by
* Spouses Name
* Spouses Date of Birth
* Spouses Age
* Children (Name/Age)
* Church
* Refered by
* Prefered appointment time
Would you like to be notified of any upcoming healing seminars,t training sessions, etc?
Yes
No
* What is the primary reason(s) you are coming for ministry?
* Please check any of the following conditions that apply to you.
Headaches
Dizziness
Fainting Spells
Palpitations
Stomach Trouble
No appetite
Fatigue
Insomnia
Nightmares
Flashbacks
Anxiety
Tense
Panic Attacks
Depressed
Suicidal thoughts
Sexual problems
Can't keep a job
Marital problems
Inferiority
Outburst of tears
Anger
Jealousy
Fear
Financial problems
Relationship problems
Parenting issues
Rejection
* Do you have any physical disease?
Background
* How would you describe the atmosphere in your family of origin?
* Describe your childhood relationship with your father.
* Describe your childhood relationship with your mother.
* Describe your mothers pregnacy and delivery with you.
Easy
Difficult
Don't Know
* Primary care giver, ages 0-6
* How many brothers?
* How many sisters?
* Your birth order?
Significant Past Events
* Sickness
* Injuries
* Hospitalizations
* Handicaps
* Failures
* Deaths
* Verbal or Emotional abuse
* Physical abuse
* Sexual abuse
* Divorces
* Other
* Who have you seen recently to help you deal with life's issues?
* Have you had a medical check up recently?
Drug/Alcohol Addictions
* Family
* Self
* Are you currently on any medications?
* Is there occult or Masonic involvement in your family background?
* Have you had any significant events, dreams or emotional upsets lately?
Spiritual/Religious Background
* Have you ever invited Jesus Christ into your life?
* If yes, please tell us when and what happened. Also describe your current relationship with the Lord.
Waiver of Liability Instructions
1. All applicants for Personal Prayer Ministry must read and sign the Waiver of Liability and Waver of Confidentiality. 2. After placement has been made for Prayer Ministry, you will be assigned 2 prayer ministers. 3. Sessions are normally 1 ½ hours in length. We try as much as possible to accommodate the schedules of individuals. 4. We want you to be aware that we are not salaried employees that are funded by a church and/or organization. While we don’t charge for Prayer Ministry sessions, we do ask for you to partner with us financially. Without funding, we cannot continue to do what we do. Therefore, we ask you to ask God what amount He would have you give to support the ministry here at Operation Light Force. The minimum donation is $50.00 per ministry session.
* My commitment for each ministry session to Operation Light Force is?
Wavier of Liability
*I declare that I am coming into this ministry arrangement of my own free will. *I understand that during these ministry sessions I will be confronting inner feelings and emotions, which could cause emotional pain. * I understand that I will be seeing trained Personal Prayer Ministers who will be able to listen, support, encourage, pray with, and minister to me to help me overcome my problems and to grow in my Christian life. * I understand that the Operation Light Force ministry team is offering prayer ministry by faith along with personal encouragement. They are not offering services as professional or licensed counselors, therapists, medical or psychological practitioners. I accept that they are not licensed psychologists and that they minister according to principles of the Christian Bible. * I understand that, at any time, either myself, or my Personal Prayer Ministers may refuse to engage in further communications and/or ministry and be free to terminate sessions with no further ministry, or obligation on anyone’s part. * I accept that I may be referred to other sources of ministry or counseling. * I acknowledge that ministry is under the direction and control of the Holy Spirit, and that no guarantees are made, nor can be made, by anyone or any organization, that I will or will not receive any particular healing. Thus, I waive all rights to claims of liability. * I indemnify and agree to hold the host facility, Operation Light Force and the OLF ministry team members harmless for any of my personal responses to the teachings and ministry I receive.
Waiver of Confidentiality
* I am aware that all statements that I shall make are of a confidential nature, including all written information, and that legally and ethically this may not be disclosed without my written consent. However, I waive my right to “complete” confidentiality in the following situations: * Your Personal Prayer Ministers may need to do a consultation with others involved in prayer ministry in some situations. * I accept and acknowledge that Personal Prayer Ministers or any other persons involved in working with adults and children in a helping setting, are either encouraged or required by law to disclose to the appropriate authorities, any harm or potential harm that a person may attempt or desire to do to himself/.herself (such as suicide), or to others. * I accept and acknowledge that they are also required to report any reasonable suspicion of physical or sexual abuse that has been done, or that is being done to a minor child, spouse or elderly person. * I accept that all Personal Prayer Ministers reserve the right to make such reports as mandated by law. By my signature I acknowledge that I have read and understand all of the above provisions, including the Waiver of Liability and Waiver of Confidentiality, and that I accept the stated conditions and limits of liability and confidentiality.
* Printed Name
* Signature
* Date

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