Bethesda Inner Healing INtake form Name * First Name Last Name Email * Phone (###) ### #### Birthdate * MM DD YYYY Gender * Female Male Have you ever received inner healing ministry in the past? * Yes No If yes, when and what ministry? Why would you like to receive inner healing? * Are you currently struggling with anxiety, depression, nightmares, headaches or night terrors? * Please specify below Have you been the recipient of sexual, emotional, physical or spiritual abuse? * If so, please specify below. Thank you for sharing! Our team will be praying for you leading up to your session! We look forward to partnering with you on your inner healing journey with Jesus!Bethesda Inner Healing Team
