Contact Details:
. 3476 West 71st Los Angeles, CA,
90043. Oklahoma Broadway St,
Moore, Ok 73160-4814
. (405) 532-1555
PREP FORM: SPIRITUAL DIRECTION IN MARRIAGE AND FAMILY
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To make the best use of our time together, please fill out this spiritual direction questionnaire Form completely. It would help set the agenda for your spiritual direction session. It also helps me to be as prepared as possible. Please electronically fill this form and SUBMIT to me at least 24 hours prior to each session. Your information is held in strict confidence.
Name
*
First
Last
What am I most grateful for/proud of this past week:
*
What I didn’t get done that I had intended to do
*
The challenges I am facing now:
*
The opportunities available to me this week:
*
During our spiritual direction session, I want to discuss:
*
Since our last meeting I have accomplished:
*
Insights, choices, decisions since our last call
*
As we wrap up the spiritual direction session, write down what you plan/ agree to work on before our next spiritual direction session
*
Date & Time of Next Call
*
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CLOSE
PREP FORM: SPIRITUAL DIRECTION
Please enable JavaScript in your browser to complete this form.
To make the best use of our time together, please fill out this spiritual direction questionnaire Form completely. It would help set the agenda for your spiritual direction session. It also helps me to be as prepared as possible. Please electronically fill this form and SUBMIT to me at least 24 hours prior to each session. Your information is held in strict confidence.
Name
*
First
Last
Email
*
Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Date / Time
Date
Time
Phone
Is there anything currently burdening your heart or mind?
*
Briefly describe your spiritual background and/ or faith tradition
Close and growing
Dry or distance
Confused or unsure
Seeking connection
Other
What spiritual practices are currently part of your life?
Prayer
Bible Reading
Worship
Fasting
Reflection/Meditation
silence
Journaling
What areas do you need guidance in right now?
Developing a prayer life
Discerning God's will
Hearing God's voice
Identity, purpose and calling
Managing transitions
Overcoming fear or anxiety
Emotional or Inner healing
Strengthening spiritual disciplines
Emotional/ mental clarity
Managing relationships/Marriage
Other
How would you like to meet for spiritual direction?
Weekly
Bi-weekly
Monthly
As needed
Preferred format for sessions
In-person
Phone call
Zoom or online video
Written Via emial
Written via WhatsApp
Other
Submit
CLOSE
SPIRITUAL DIRECTION: MARRIAGE AND FAMILY QUESTIONNAIRE
Please enable JavaScript in your browser to complete this form.
To make the best use of our time together, please fill out this spiritual direction in marriage and family questionnaire Form completely. It would help set the agenda for your spiritual direction in marriage and family session. It also helps me to be as prepared as possible. Please electronically fill this form and SUBMIT to me at lease 24hrs prior to first session. This spiritual direction in marriage and family / spiritual direction questionares are only filled out before the first session. Your information is held in strict confidence.
Name
*
First
Last
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Telephone (home)
Home
Telephone (office)
Phone
*
Email
*
Date of birth
*
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Occupation
*
Marital Status
*
Single
Married
No. of children
Selected Value:
1
If Any
Religious Affiliation
Place of worship
Please feel free to complete your responses
1. Do you think that our modern society has departed from the biblical understanding of marriage as described in Genesis 2:24?
*
Yes
No
2. Do you think the government should promote laws that encourage the biblical understanding of marriage and family?
*
Yes
No
3. Should your state or local government have legislative power to impose upon families and marriages - God’s intention for marriage and family as seen in creation?
*
Yes
No
4. How much involvement do you think that the local government should have in such matters?
Strong
Weak
None
In one week
5. Do you believe that sin brought a reversal of male – female roles in marriage and family?
*
Yes
No
6. Should a father exercise his responsibility as head of the home?
Yes
No
In one week
7. If you are a mother / wife - do you apply the Bible teachings on your responsibilities as mother /wife?
*
Yes
No
8. How would you describe your family/ marriage? Is it an ideal one?
*
Yes
No
9. Is your marriage/ family characterized as ideal?
*
Yes
No
10. Do you think God has an opinion in your marriage/ family?
*
Yes
No
11. Do you believe that a family that prays together - stays together?
*
Yes
No
12. Has your marriage/ family got a relationship with God?
*
Yes
No
13. Do you experience God daily in your marriage and family?
*
Yes
No
14. What are you currently using as a basis for your prayer? How often do you take time for family prayer? How long are your prayer times?
*
5 minutes
30 minutes
60 minutes or more
15. Do you hope to gain from spiritual direction?
*
Yes
No
16. What days/times are more convenient for you to meet with a spiritual director?
*
Days
Evenings
Weekends
16. What led you to seek spiritual direction at this time?
Signature
Clear Signature
Submit
CLOSE
SPIRITUAL DIRECTION QUESTIONNAIRE
Please enable JavaScript in your browser to complete this form.
To make the best use of our time together, please fill out this spiritual direction questionnaire Form completely. It would help set the agenda for your spiritual direction session. It also helps me to be as prepared as possible. Please electronically fill this form and SUBMIT to me at least 24hrs prior to first session. This spiritual direction in marriage and family / spiritual direction questionares are only filled out before the first session. Your information is held in strict confidence.
Name
*
First
Last
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Telephone (home)
Home
Telephone (office)
Phone
*
Email
*
Date of birth
*
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1956
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1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Occupation
*
Marital Status
*
Single
Married
No. of children
Selected Value:
1
If Any
Religious Affiliation
Place of worship
Please feel free to complete your responses
1. Do you have a relationship with God?
*
Yes
No
2. Are you experiencing God in your daily life?
*
Yes
No
3. Do you often take time for personal pray?
*
Yes
No
4. How often do you pray?
Once
Twice
Frequently
In one week
5. Is the power of prayers working in your life?
*
Yes
No
6. How long are your prayer sessions?
5 minutes
15 minutes
30 minutes and more
In one week
7. Do you hope to gain from spiritual direction?
*
Yes
No
8. What days/times are more convenient for you to meet with a Spiritual director?
Days
Evenings
Weekends
9. What led you to seek spiritual direction at this time?
Signature
Clear Signature
Submit
CLOSE
Request An Appointment
Request An Appointment
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Please fill out this form
Name
*
First
Last
Email
*
Phone
*
Location Preference
*
Type of service
*
Individual Session
Couple Session
Do you have a preference for in-person or tele-spiritual direction ?
*
In-Person
Telehealth
Do you prefer a male or female Direction?
*
Male
Female
Date / Time
*
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1920
Date
Time
Any Questions / Comments?
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