Phone number *
Phone type Mobile Home Work Other
Gender *
Select… Male Female
Marital status *
Select… Single Married Widowed
What church do you attend? *
Have you received freedom prayer from City Church recently or in the past? *
Select… Yes No
Do you have a medical diagnosis (mental health, etc.) that you are willing to share? *
Do you feel you are addicted to anything at this time? *
List addiction if you marked "Other".
What are you looking for freedom from? *
Would you be willing to pray and fast the week before? *
For example, fasting can take shape in many ways, i.e. television, gaming, internet, food, shopping, negative words or thoughts, something you are obsessive about, reading, exercising, or anything that someone who knows you says takes up too much of your time?
Select… Yes No
Do you have a gender preference for your prayer team? (please understand that we will do our best to accommodate according to available team members). *
Select… All Male All Female Both Male and Female No Preference
I ACKNOWLEGE: Members of the City Church Freedom Ministry team have voluntarily agreed to pray for me. I understand that this session is not a professional counseling meeting and that none of the team members are licensed counselors and/or are not meeting with me in a professional counselling capacity. I understand that these team members are, to the best of their ability, doing what they can to help me achieve more freedom in my life. I understand that City Church is a nonprofit corporation that makes no charge for its services. I further state that I have voluntarily sought assistance of my own initiative and that I'm under no obligation to accept or reject any of the advice or help that I might receive from the team members of this church. City Church offers Biblical spiritual services to anyone who desires them regardless of their ability to pay.
Submit
