5/10/25
client
Do you currently attend a church? If so, please share the full name, city, and state. (if not just write n/a)
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If you do belong to a church, who are the individuals actively discipling you and what are their roles at the church? (if you don't just write n/a)
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If you’re not currently part of a church, do you have any spiritual mentors or belong to any ministries? If so, who are they and what roles do they have? (if you don't just write n/a)
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Age Range
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Briefly share what you're currently walking through and why you're seeking help.
(Example: struggling with anxiety, addiction, spiritual heaviness, etc.)
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Have you previously received any help or support for what you’re walking through?
(This could include things like counseling, pastoral care, prayer ministry, support groups, deliverance ministry, or any other form of spiritual or emotional support?)
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If so, please describe what you’ve tried, when it took place, and how it helped (or didn’t help).
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What is your relationship with Jesus right now?
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What kind of support are you hoping for through Free and Fearless? (check all that apply)
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What is your general daytime availability for appointments (Monday–Friday only)?
- We offer a limited number of evening appointments, so please give us as many weekday daytime options as possible.
- To help us schedule, please list at least three specific dates and times within the next three weeks that would work well for you, or let us know any days/times you’re consistently available during the week.
- If evenings are your only option, please let us know your evening availability, and we will do our best to make it work.
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Is there anything else you’d like us to know?
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