True Wholeness Survey

This is a short seven-question survey. It is highly confidential as we will not know who has responded but it will help us in knowing how to best serve those in need. Thank you in advance for your assistance.

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* 1. What does inner healing or wholeness mean to you?

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* 2. If you have ever participated in inner healing before, describe that experience.

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* 3. If you have participated in a deliverance session, describe that experience.

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* 4. Please check the areas that are a challenge for you: (By challenge, we mean that despite your best efforts, you’ve not been able to overcome them). Check as many as apply.

Rejection

Unforgiveness

Fear

Anger

Overeating

Anorexia/Bulemia

Depression/Anxiety

Alcohol

Drugs

Sex/Fornication

Betrayal

Bitterness

Jealousy/Envy

Offense

Swearing

Other (please specify)

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* 5. How likely are you to commit to learning how to overcome the areas you checked in # 6?

Likely

Unlikely

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* 6. Have you accepted Jesus Christ as your personal savior?

Yes

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* 7. Have you been baptized by water as result of your salvation?

Yes

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* 8. Contact Information

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number