Inner Healing & Freedom Session Request FormInner Healing Ministry Request Personal Information First Name * Last Name * Cell Phone Number * Email Address * Are you 18 years of age or older? * YesNo Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe CountryInner Healing Specifics Have you ever been through an Encounter Inner Healing & Freedom session? * YesNo What was the date of your last session? * Name of the inner healing leader that ministered to you. * Did this leader recommend a follow up session? * YesNo, but I really feel I need a follow up session. Please describe your goals for another session. * Please describe why you are seeking out an inner healing session at this time? * Would you consider yourself a committed Christian? * YesNo Have you received some kind of formal inner healing ministry in the past? * YesNo Please describe the ministry you received and the fruit? * Are you under the care of a behavioral health professional? * YesNo Do they support your decision to seek inner healing prayer at this time? Please explain. * Do you have others around you to support you on your healing journey with Jesus after your session is completed? * YesNo Please explain your spiritual circumstances * Are you comfortable receiving prayer from either a male or a female prayer leader? YesNo Acknowledgments Although there is no fee associated with receiving this ministry, we do ask everyone who receives to donate to this ministry to provide a stipend for our inner healing and freedom ministers. * I am happy to consider a donation to this ministry after my session.I am not interested/able to donate to this ministry after my session. I understand that prayer sessions are over the internet via Zoom. * Yes, I understandI understand that completing this form does not indicate a commitment on the part of Encounter Ministries to provide me with an Encounter Inner Healing & Freedom Session, it is simply the first step in the process. * Yes, I understandOptionalHow did you hear about our Inner Healing Ministry? How did you hear about our Inner Healing Ministry? Internet Search An Encounter Ministries Event A recommendation (please tell us who)A recommendation (please tell us who) OtherOther reCAPTCHA If you are human, leave this field blank. Submit