If applicable, please describe your relationship to Hope Christian Church?

How did you hear about this ministry?

Do you have preferred days and times for sessions (am/pm)?

Please share any scheduling constraints.

Have you previously received ministry at HCC? If so, when?

Are you currently in counseling?

Acknowledgment of the Ministry's Faith-Based Approach

I acknowledge that Hope Healing House provides ministry services based on Christian principles and the truth of God's Word. I understand that this ministry is not a substitute for professional counseling, psychological or medical services. The ministry team relies on prayer, scripture, and the leading of the Holy Spirit to guide the healing process. By signing below, I affirm my willingness to engage in a faith-based approach to emotional and spiritual healing.

Confidentiality Agreement

I understand that all information shared during ministry sessions will be kept confidential and will not be disclosed outside of the Hope Healing House ministry team, except in the following situations:

If I present a danger to myself or others.

If there is suspected abuse or neglect of a minor, elderly person, or vulnerable adult.

If disclosure is required by law.

The ministry team may also consult with senior ministry leaders for the purpose of providing the best care, while maintaining confidentiality and discretion. I agree to respect the confidentiality of others who may be receiving ministry, and I release Hope Healing House from any liability in the event of a necessary legal disclosure.

Consent to Participate in the Selected Ministry

I voluntarily consent to receive ministry through the selected format (Issue-Focused Ministry or Thorough Format Ministry) at Hope Healing House. I understand the nature, purpose, and structure of the ministry sessions and acknowledge that I am choosing to participate willingly. I understand that my participation involves prayer, discussion, and spiritual guidance rooted in biblical truth, and I give permission to the ministry team to minister to me in this way.

Agreement to Adhere to the Policies and Guidelines of Hope Healing House

I agree to abide by the policies and guidelines set forth by Hope Healing House. I understand that participation in ministry is a privilege and not a right, and the ministry team reserves the right to discontinue sessions if necessary due to non-compliance, disruptive behavior, or any violation of the established policies. I agree to participate respectfully, arrive on time, and engage with the process to the best of my ability.

Statement of Liability Release

I understand and acknowledge that the ministry services provided by Hope Healing House are voluntary, biblically-based, and offered by trained ministry volunteers, not licensed counselors or healthcare professionals. I recognize that the ministry process is spiritual in nature and not intended to diagnose, treat, or cure any physical, emotional, or mental condition.

By signing below, I release Hope Healing House, Hope Christian Church, its pastors, staff, ministry volunteers, leaders, and affiliates from any and all liability, claims, or demands for any personal injury, emotional distress, or damages of any kind that may result from my participation in ministry sessions.

I assume full responsibility for any decisions or outcomes resulting from my participation and understand that I am free to withdraw from ministry at any time.

Referral Clause

I understand that while Hope Healing House provides spiritual support through prayer and biblical guidance, there may be times when additional professional care is recommended. In such cases, I acknowledge that the ministry team may suggest referral to licensed counselors, healthcare professionals, or other appropriate resources.

I understand that it is my personal responsibility to follow up on any referral recommendations and that Hope Healing House does not assume responsibility for the services, practices, or outcomes provided by external professionals or organizations. I acknowledge that all referrals are made in good faith with my well-being in mind.