Questionnaire

Please be as honest as you can with yourself when you fill out this questionnaire. There is no right or wrong, we are all on a journey in our faith and there is no failure, only room to grow and mature in Christ. Your answers just help me know where you are in your walk with God and what your goals are.

1-10 Scale: 1= Not at all, 10= Fully/Completely

Frequency scale: 1= Rarely (1-2 x’s a week or less), 2= Occasionally (almost daily), 3= Frequently (daily), 4= Most of the time (for big decisions or feelings during the day), 5= Almost constantly (try to take each thought, feeling and decision and run it through God first)

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On a scale of 1-10, how close do you feel to God right now in your life on a daily basis?

On a scale of 1-10, what is the closest you have ever felt to God?

How long ago was this and how long did it last?

Can you remember why you felt this closeness?

Using the frequency scale above, how frequently do you pray?

Using the frequency scale just numbers 1-3 above, how frequently do you read the Bible?

On a scale of 1-10, how close do you truly want to feel to God?

Please list any blocks you feel you have that are hindering your closeness to Him.

On a scale of 1-10, how much do you truly believe or trust that God can heal your emotional and cognitive/behavioral problems?

On a scale of 1-10, how much do you believe the Bible is the truth and is the only source of answers for all our life’s problems?

On a scale of 1-10, how much of a role do you feel the Holy Spirit has in your life daily?

On a scale of 1-10, how willing are you to surrender yourself to the process of healing through the work of the Holy Spirit in you?

Please write a brief description of how you know you are a Christian/your salvation story

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