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Healing the Heart Prayer MinistryYou were created to be whole and free! This premise is foundational to the prayerministry offered at Life Center Ministries. Today you can choose life and begin yourjourney to real freedom in Jesus Christ. It is for freedom that Christ has set you free!(Galatians 5:1)Our goal as prayer ministers is to facilitate this process by the examination ofthe fruit in your life. Through the ministry of the Holy Spirit, bad fruit can be traced tobad roots, i.e., judgments, inner vows, unforgiveness, resentments, and lies adoptedinto our belief systems earlier in life. During the prayer sessions, the Blood of Jesus, theCross, and the Resurrection of our Lord Jesus Christ are all applied to the deep woundsand practices of the heart. Healing and wholeness result as we allow God’s faithfulnessto complete the work He has already begun in you. (Philippians 1:6)If you are interested in receiving prayer ministry, please complete the attachedforms and return to Life Center Ministries. Upon receipt of these forms, a prayerminister will contact you to schedule your initial appointment. Please note that a 24hour notice is requested for any necessary appointment changes. We do ask that youschedule your next appointment at the close of each session.We have seen greater success in the outcome of our efforts when those receivingministry value what they receive. By taking the opportunity to sow financially, you alsodemonstrate your commitment to the healing process. Further, you are sowing into theministry and the vision to bring healing to lives so they can pursue their destiny in God.Your donation can help bring healing to others who are financially unable to donate. Asuggested donation of 60.00 per hour for individual sessions or 120.00 per hour isrecommended for team sessions. However, individual arrangements can be discussed asthey arise. All are welcome regardless of financial status. Donations for servicesrendered are not tax deductible. Please note that we do not accept insurance, and wedo reserve the right to refuse service if we perceive abuse of service or grace extended.We strongly believe that as you take responsibility for your healing, God will releaseblessing and honor into your life.The prayer ministry at Life Center Ministries is dedicated to bringing wholenessto the lives of individuals in the name of Jesus Christ. Our trained and experiencedteam has a heartfelt desire to see people come to genuine freedom. By facilitating theprocess of sanctification through personal prayer ministry and teaching, we havewitnessed remarkable transformations through the power of the Holy Spirit. We extendto you this same hope for change, a hope that does not disappoint because the love ofGod has been poured out in our hearts. (Romans 5:5)Please mail attached forms directly to:Healing the Heart Prayer MinistryLife Center Ministries411 South 40th StreetHarrisburg, PA 17111
Pre-Ministry History FormThe purpose of this questionnaire is to obtain a comprehensive picture of your background. By completingthese questions as fully and accurately as you can, you will facilitate your prayer ministry. All information thatyou share with prayer ministers is strictly confidential and will not be disclosed without your permission.Personal HistoryName Home phone ()AddressCity State ZipOccupation Work phoneSex Age Birthdate Marital StatusEducation: (Circle last completed)High School: 9 10 11 12Grade school: 1 2 3 4 5 6 7 8College: 1 2 3 4Other:Physical Health: Very Good Good Average DecliningList past trauma, illnesses, injuries, handicaps, destructive patterns, etc.Have you ever used drugs other than for medical purposes? What?Have you ever had psychotherapy or counseling? When?From whom?Describe any legal issuesParent/Parent Substitute HistoryNatural Parents: Married Separated Divorced Never MarriedFather Deceased Mother DeceasedYour age: When parents separatedAt time of mother’s deathAt time of divorceAt time of father’s deathYou lived with: Mother Father Other How long?Father remarried when you were age You lived withMother remarried when you were age You lived withHow did step parent(s) relate to you? (kindly, poorly, affectionately, little discipline, etc.)Natural father’s occupationNatural mother’ occupationHow many times was your father married? Your Mother?Rate parents’ marriage: Unhappy Average Happy Very HappyTheir marriage lasted: years.
Rate your father’s second marriage:Rate your mother’s second marriage:Rate your childhood life:You left home at what age?List your brother and sisters (including step-brothers/sisters) in line of succession, indicating sexand age: [e.g. John (male), 23 yrs.; Joan (female), 21 yrs.; (me) 15 yrs.; Sue (female) ]Describe relationships with natural parents:Describe relationships with stepparents:List present interests, hobbies (e.g. internet, sports, movies, etc.)How do you spend your spare time?Marriage InformationName of Spouse Age ChurchOccupation Work phone ( )Is your spouse willing to come for prayer ministry? Yes No UncertainHave you been separated? Yes NoHave either of you filed for divorce? Yes NoDate of this marriage Age when married: Husband WifeGive brief information about any previous marriages or “live-in” relationshipsBroken by: Divorce Death OtherCircle areas in your marriage that need improvement: financial, sexual, spiritual, husband’sLeadership, wife’s role, child training, other (please specify)Information about ChildrenPM*NameAgeSexWhere living/OccupationMarried?* Check PM column if children are by a previous marriage
Spiritual BackgroundChurch affiliation Pastor's NamePastor/Church phone # Does your pastor know you are seeking help?Spouse's church affiliation Does your spouse know you are seeking help?What is your relationship with God?Explain recent changes in your spiritual life, if anyBriefly Answer the Following QuestionsWhat is the main problem, as you see it? What are your goals in coming for prayerministry?Describe your spouse’s personality.As you see yourself, what kind of person are you?List three significant relationships (friends, family, etc.)Were you or any member of your family knowingly involved in the occult (e.g. astrology,superstitions, New Age thinking, horoscopes, Masons, etc.)? List any.Is there any other information that would be helpful for us to have?How strongly do you want healing from your problem? (circle one)Very MuchModeratelyCould do without, if necessaryWho referred you here for prayer ministry?Have you previously received ministry from Healing the Heart? Yes NoIf yes, when and from whom?Times of Availability:MTWTFAMAMAMAMAMPMPMPMPMPM
MINISTRY RELEASE AND DISCLAIMERDisclaimer, Information, and AgreementNameAddressCity State ZipPhone(s) Home Cell WorkEmail Text #The purpose of this ministry is for spiritual growth and healing. It is not a psychological counselingservice, nor is it intended to be. Team members are not licensed psychologists orpsychiatrists; however, they are trained in using the Word of God and prayer through the power of theHoly Spirit. The results of this approach depend on the willingness of the individual to make wise choicesconsistent with the teachings of Jesus Christ.All personal information gathered in the course of a ministry session is confidential, and the files are somaintained. Prayer ministers may consult with other team members without the use of individuals’names.Discipleship, the commitment to train others in the mastery of prayer ministry skills, is an ongoing aspectof prayer ministry. Qualified disciples may be assigned during ministry sessions. The adherence to astrict policy of confidentiality includes disciples working with prayer ministers.To comply with legal regulations, any planned or recently attempted suicide, threats to harm self orothers, reports of child abuse, or criminal behavior will be reported to the proper authorities.I , understand the above information concerning this ministry.I have sought this ministry of my own free will. All personal information I reveal is given voluntarily inorder to facilitate the team members working with me. I further release the Life Center MinistriesInternational and the Prayer Ministry from any liabilities and retributions that may result from thesesessions.Security Camera PolicyLife Center Ministries International and Healing the Heart Prayer Ministry value the privacy,confidentiality, and security of both the ministry team members and their clients. The use of surveillancecameras is currently being employed in all ministry rooms and hallways.* There is no audio recording. The cameras are for surveillance only and do not have audiorecording capability.* There is no real-time monitoring of the video stream. The video footage is recorded. Recordedfootage will be viewed only in the event of an investigation involving security.SignatureDateOffice Use OnlyPre-Ministry Forms returned to meInitialsDateInitialsDate
Consent to Release of InformationAs a ministry receiver, I give my permission for any psychological/physical/personalinformation to be exchanged between the prayer minister and those checked below toassist in the ministry process:Physician/Medical PersonnelName Phone #Psychiatrist/PsychologistPhone #Other Counselor/Mental Health ProviderName Phone #AttorneyName Phone #Pastor/Church LeadershipName Phone #OtherName Phone #SignaturePrinted NameDate
ministry value what they receive. By taking the opportunity to sow financially, you also demonstrate your commitment to the healing process. Further, you aer sowing iton the ministry and the vision to bring healing to lives so they can pursue their destiny in God. Your donation can help bring healing to others who are financially unable to .
