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How would you prefer to be contacted? TEXTPHONE CALLEMAIL
May we send you a reminder, by the above selected preference, prior to your appointment? YESNO
Please check any past or present issues you currently struggle with: (SELECT ALL THAT APPLIES) AbortionAbuseAddiction / CompulsionFamily IssuesFear / PhobiaFinancialGrief / LossHidingLonelinessMarital ConflictOccult InvolvementPerfectionismPremarital SexRecent Personality ChangeSexual Issues / AbuseSuicideTrauma
Do you have a clinical diagnosis? If yes, please fill in below.
Are you currently under the care of a Therapist/Psychiatrist? YESNO
Will you be able to fast and/or pray one week before your SOZO? YESNO
Would you be comfortable being ministered to by someone of the opposite sex? YESNO
Why would you like to receive SOZO? Please briefly explain:
Ask the Lord what He wants you to fast...it can be anything from one meal a day to watching TV. For the value of the time ministering to you, there is a suggested donation of $50.00. You may send the donation, payable to River Valley Church or submit it online. Please complete this application and accept the Liability Release Form
I acknowledge that team members from River Valley Church 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. I understand that these team members are, to the best of their ability, doing what they can to help me achieve freedom in my life. I understand that River Valley Church is a nonprofit California Corporation that makes no charge for its services. I further state that I have voluntarily sought assistance of my own initiative and that I am under no obligation to accept or reject any of the advice or help that I might receive from the team members of this ministry. Our team members offer biblical spiritual services to anyone who desires them regardless of ability to pay. Although there is no charge for our services, all efforts to build this ministry support and train our team members are paid directly from the donations of those receiving these services. We therefore have a suggested donation of $50.00 or more per visit. Your contributions to this ministry are greatly appreciated because they support our further development. If you would like a tax deductible receipt, we will provide one for you in the church office. Thank you! I understand that if I receive ministry from River Valley Church , the team is committed to respect the disclosed information, but not to complete confidentiality. The information, as needed, may be shared with other leaders of the Ministry so as to further your total healing process. This may include future meetings with Spiritual mentors in the church to set appropriate boundaries for your personal and spiritual growth. I agree to hold River Valley Church team members free from any and all liability, loss or damage of any kind that may arise as a result of assistance which I have received or from any involvement with River Valley Church.
I have read the above statement and agree to the liability release:I agree
Please Type your name below as your signature for the liability release: Today's Date