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Pre - Counseling Call Questionnaire
Please complete at least 24 hours prior to your booked session. Confidentiality - What you share with me in writing and during the counseling call will be held in confidence.
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Important Notice!
I am a Minister of the Christian faith and provide Biblical - Based
guidance and counsel to help you with the issues you share with me in the
questionnaire and what you verbally communicate with me on the call. I am not a
licensed psychologist, I am not psychiatrists, and I am not a therapist .
My goal is providing Holy Spirit-led Christian counseling, prayer and prophetic ministry to help, edify, encourage
you during this time of need.
Name
*
Your answer
Email
*
Your answer
Phone Number
*
Your answer
City and State
*
Your answer
What is your gender?
*
Female
Male
Required
What is your occupation?
*
Your answer
Are you a Christian (Jesus Christ is Lord & Savior in your life)?
*
Yes
No
Required
Are you filled with the Holy Spirit with the evidence of speaking in tongues?
*
Yes
No
Required
What is your marital status?
*
Single
Married
Divorced
Separated
Required
Do you have any children?
*
Yes
No
Required
Briefly describe and summarize the situation you are requesting counseling for:
*
Your answer
Agreement: You agree that you will not pursue any legal action against me as it relates to the Biblical Faith-Based Counseling and prayer that I provide. You understand that it will be up to you as to whether you apply and how you apply the guidance I provide. You also understand that there shall be no refunds.
*
Yes, I have read the above and agree by checking the box.
Required
Note you may sow your love gift to
Prophetess Equilla Miller by Cash App $emmfields
If you don't have Cash App; you may send by Western Union, Moneygram or Walmart 2 Walmart.
If using a method other than Cash App,
be sure my name only as receiver:
Equilla Miller, Florida for Pick Up (do not put Prophetess)
Please send your gift at least 10 minutes prior to the session:
*
Option 1 a 30 Minute Session - Sow a love gift of $75 or more by Cash app $emmfields or online Western Union or Moneygram
Option 2 a 45 - 60 Minute Session - Sow love gift of $100 or more by Cash app $emmfields or online Western Union or Moneygram
Required
How did you learn about Prophetess Equilla? What platform or platforms do you follow her on:
*
Facebook
Twitter
LinkedIn
YouTube
Instagram
Time in the Secret Place Broadcast
Website
Required
Send an email to prophetessequilla@gmail.com to notify that your pre-counseling form has been submitted.
You will receive a confirmation and scheduling notice from Prophetess Equilla Miller as the next step to the appointment.
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