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 Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe 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