Personal Prayer Ministry

Changing the world
one person at a time…

Thank you for your inquiry!

This application form will take perhaps 20 minutes to complete if you fill in most fields. The optional fields can help you clarify root issues more quickly if you feel they are important, and also help us gain a better understanding of your life situation. (Only significant highlights are needed, not your entire life story.)

Please note that field labels with an (R) are required (only name, email and session preferences). Information is kept private and not used for any other purpose.

The "Finish" button to submit the application is located at the bottom of the last page (Step 5, Significant Past Events).
Your biological gender:
Your marital status:
What is your preferred appointment day(s), Mondays through Thursdays? (R)
What is your preferred time (calculated to Eastern Time in North America)? (R)
(If you are located internationally in a vastly different time zone, explain at the end of this form under "Any other questions". We will try to accommodate the time zone differences.)
Your preferred session mode? (R)
Please check any of the following symptoms that you have been experiencing:
Have you had a medical checkup in the last year?
Briefly describe any significant past events:
Thank you for taking the time to complete the application.

Our desire is to be as warm and personal as possible. However, those in helping professions need to satisfy the legal requirements of informed consent.

By submitting your application, you are acknowledging that you have read and accept the legal waivers at this link. (This will open in a new window, which you can close when finished, before clicking the "FINISH" button below.)