Prayer Intake Form | Everfree Prayer Ministries

Date(Required)

Name(Required)

First Last

Phone(Required)

Email(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

PRAYER AGREEMENT & CONSENT(Required)

Please read carefully before scheduling a prayer appointment.
PARTICIPATION REQUIREMENTS

This form must be completed by the person seeking prayer. Please do not fill out this form on behalf of anyone else. You participate voluntarily and work with us only as you choose.

NATURE OF THIS MINISTRY

Everfree Prayer Ministry offers listening prayer–based sessions. This ministry is spiritual and pastoral in nature and is considered prayer ministry, not professional or clinical counseling.

We are ministers and prayer mentors, not licensed counselors, therapists, or mental health professionals. We do not provide clinical advice, diagnosis, or treatment and are not a substitute for professional care. We do not act as experts over your life or promise specific outcomes. We facilitate the process, but the Holy Spirit is the true guide.

WHAT TO EXPECT

In each appointment, we:

Listen to the Holy Spirit with you.
Help you recognize how you personally hear God’s voice.
Invite God to highlight areas of your story needing His healing, truth, or presence.
Address spiritual warfare by removing anything that interferes with encountering Jesus.
Create space for you to experience His love, freedom, and guidance.

Our goal is to equip you with tools, practices, and confidence to continue walking in freedom, hearing God clearly, and using your God-given authority in everyday life.

We have no fixed agenda for sessions and expect our time together to be led by the Holy Spirit. Inner healing and deliverance prayer often brings a “spurt” toward wholeness in each session, though professional counseling may sometimes be advisable—especially when dealing with dysfunctional habits. It is always advisable to actively pursue spiritual disciplines such as church attendance, prayer, Bible study, and worship.

For training and ministry development purposes, a trained observer may be present on your prayer call. Observers are bound by confidentiality. After an introduction, they will keep their camera off, remain muted, and participate only through silent prayer.

COMPLIMENTARY SESSION & ONGOING SUPPORT

Everyone receives one complimentary two-hour prayer appointment. Everfree is able to provide this ministry through our financial partners. If you wish to make a donation to this ministry, information is available on the DONATE tab at www.everfreeprayer.org. Donations are optional.

Beyond this initial prayer session, Everfree provides resources intended to support continued growth in hearing God’s voice, walking in freedom, and living out your God‐given identity. Learn more about additional resources, FAQs, curriculum, and coaching/training opportunities at www.everfreeprayer.org.

CONFIDENTIALITY

We are committed to keeping confidential whatever you share with us. However, we are legally required to report:

Any intent to take harmful, dangerous, or criminal action against yourself or another person, or
Any act of child or elderly abuse or neglect.

If such reporting is required, that intention will be shared with you first.

TRANSCRIPTION OF SESSIONS

Prayer sessions will be transcribed using Zoom’s live transcription feature for internal training, quality, and ministry development purposes only. Transcripts are not shared publicly, used for marketing, or distributed outside Everfree Prayer Ministry, and identifying information is handled with care.

STATEMENT OF RELEASE

By signing this agreement, I release Everfree Prayer Ministry and its facilitators from any liability if this ministry session does not meet my expectations or results in any spiritual, emotional, or physical discomfort or dysfunction.

COMMUNICATION CONSENT

By agreeing to this consent, I understand that I will be added to Everfree’s mailing list for other ministry opportunities. I understand that I may unsubscribe at any time.

Did you read the above PRAYER AGREEMENT & CONSENT and agree to its stipulations? By checking this box, you digitally sign this form.

Are you a leader in a ministry or a church?(Required)

Yes

Gender(Required)

Male

Female

How did you hear about Everfree Prayer? (check all that apply)(Required)

Online Search

I found your Podcast

Social Media

Friend

Other

What has led you to schedule this appointment?(Required)

What do you hope will be accomplished by our time of prayer together? What are your expectations?(Required)

What is your awareness of spiritual warfare?(Required)

How old are you?(Required)

Are you married? If so, what is the name/age of your spouse?(Required)

Have you been affected by any of the following? (check all that apply)

Adultery

Miscarriage

Abortion

Rape

Incest

Sexual Abuse

Physical Abuse

Emotional Abuse

Molestation

If you have experienced abuse (sexual, physical, mental, or emotional), have you received professional counseling for these specific occurrences?

Yes

Please select the following PARENTAL relationships that apply to you: (check all that apply)

Biological Mother Alive

Biological Mother Deceased

Biological Father Alive

Biological Father Deceased

Stepfather Alive

Stepfather Deceased

Stepmother Alive

Stepmother Deceased

How was authority exercised in the home? Which parent was in charge and how did he/she operate?

How was affection shown between your parents and toward you?

Have any of your parents, grandparents or great-grandparents to your knowledge ever been involved in any occultic, cultic or non-Christian religious practices?

Briefly explain your parents' Christian experience (i.e. were they Christians and did they profess and live their Christianity?)

Regarding your family health, please select any of the following that have affected you or your family members. We do not need any medical information you do not wish to provide. All information is for internal use only. (check all that apply)

Have you ever had psychotherapy, counseling, or prayer ministry? Please explain when and how that went for you.

Have you ever experienced: (check all that apply)

Panic Attack

Severe Anxiety

Hospitalization for Mental Health

Suicide Attempt

Mental Breakdown

Select any of the following words that BEST describe you now: (check all that apply)

Rate your physical health:

How much time do you spend reading? What do you read?

Which of the following best describes how you handle positive and negative emotions? (check all that apply)

readily express all emotions

express some of my emotions but not all

acknowledge their presence but reserved

tend to suppress my emotions

find it safest not to express how I feel

tend to disregard how I feel since I can't trust my feelings

consciously or subconsciously deny them since it is too painful to deal with some of them

Do you have a problem with any of the following: (check all that apply)

Where do you currently attend worship? Who is the pastor?

How many times per month do you attend a worship gathering?

Religious background of spouse (if applicable):

Are you plagued with doubts concerning your salvation?

Yes

How would you describe your current prayer life and relationship with God? (For example: prayer frequency, ease or difficulty praying, time in Scripture, or anything you feel is significant.)

Have there been any recent changes in your faith, church involvement, or spiritual journey that feel important to share? If yes, please explain.

What are your spiritual gifts? (check all that apply)

Have you ever been involved in practices or belief systems outside of Christianity (such as psychic readings, occult practices, cults, or other religions)? If yes, please explain briefly.

Do you feel like you hear God's voice clearly? Please explain.

Do you feel able to discern God’s voice from intrusive thoughts, fear, or lies that feel discouraging or condemning? Please explain if applicable.

Describe any spiritual experiences you’ve had that felt out of the ordinary or especially significant to you.

Have you had any experience in the following cults and religions? (check all that apply)

Thank you for taking the time to complete our ministry intake form. Is there anything else that you'd like us to know before our visit?

Do you give permission for Everfree to anonymously reference something from your prayer appointment as an example in training and/or on the podcast? All identifying details are removed, and a generic name (e.g., “Suzy”) is always used.(Required)

Yes

Prayer Appointment Intake Form