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    YOUR COMMITMENT: 
    The suggested donation is a minimum of $250 per person, per session, paid at the completion of this questionnaire. We do have operating costs, and therefore we ask for a tax-deductible donation to our ministry.  
     
    Completion of the questionnaire and any pre or post session "homework.”  
     
    Willingness to forgive, repent, and maintain your freedom going forward, also to be honest and cooperative during your session.  
     
    Arranging for intercessors to cover you before and during your session. This is not required but is strongly recommended.  
     
    You are responsible for arrangements and cost of travel, lodging, meals, and transportation, if applicable.  
     
    Scheduling: upon receiving your completed questionnaire, we will email a scheduling link so that you can select the date and time of your prayer session. If you would like a Zoom video session, please indicate that in the notes portion of the screen when you schedule.  
     
     
    INSTRUCTIONS:  
    Pray before filling out this questionnaire. Ask the Holy Spirit to guide you and bring critical things to your mind.  
     
    The questionnaire is lengthy and VERY personal, but every question has a purpose! Please fill in everything honestly and to the best of your ability. We are not here to sit in judgement of you, but to aid in your healing process.  
     
    Your privacy is of the utmost importance! We utilize password protected information storage, and we never share or discuss your personal information with anyone outside of our ministry team.  
     

    Jareb and Petra Nott
    www.edt.training
    www.christianharvestintl.org 
     

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    Please Select
    • Please Select
    • United States
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curaçao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
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    Hebrews 10:24 And let us consider how to stir up one another to love and good works, 25 not neglecting to meet together, as is the habit of some, but encouraging one another, and all the more as you see the Day drawing near.
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    Single | Married | Divorced | Widowed
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    Peaceful, Chaotic, Heavy, Comfortable, Strained etc.
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    0 meaning Vengeful and Iron fisted 10 meaning Father of Love and Grace
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    Manipulative, controlling, etc.
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    • Yes
    • No
    • Yes
    • No
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    • Yes
    • No
    • Yes
    • No
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    Note, stay at home spouse/parent, and retired are valid answers
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    A co-worker of the opposite sex with whom you have a close platonic relationship.
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    Nations, Regions
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    Leave blank if N/A
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    City, State, Province, Nation
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    Denominations and/or church experience?
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    List first names if known
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    • Yes
    • No
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    Weather living, deceased, or divorced
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    Select all that apply
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    Select all that apply
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    Select all that apply
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    Please explain
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    Please explain
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    Peaceful, chaotic, heavy, comfortable, strained etc.
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    Promoting witchcraft, horror, pagan religions, sexual content, pornography
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    If yes, please give a brief description and include approximately when
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    Unhealthy means any of the following: · Keeps you in a cycle of trauma or loss · A dependency on someone or something other than God · Hinders you from moving freely into God's direction for you · Connections that give someone other than God control over your life · Connections that keep you in anger, bitterness, fear, or depression
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    Office code W
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    Office Code W
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    Office Code W
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    Office code W
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    Office code W
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    Office code F
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    Office code AC
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    Office code B
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    Office code B
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    Office code B
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    Office code DD
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    Office code E
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    Office code HP
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    Office code HR
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    Office code HR
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    Office code I
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    Office code I
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    Office code I
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    Office code J
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    Office code L
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    Office code PW
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    Office code PW
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    Office code S
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    Office code D
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    Office code SU
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    Office code R
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    Office code JZ
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