confidential personal inventory

Confidential Personal Inventory

Please Read Carefully before proceeding

ATTENTION:  The more you answer the questions below.  The better I can assist you.  Please complete and return this form.  It will be used solely for the purpose of helping you take hold of your freedom in Yeshua (Jesus Christ). If you are taking this appointment self-direct, this form will be used if you wish to set a zoom appointment with Bianca. This form is confidential and you will receive a copy after the appointment. We also can destroy it and keep no record of it. The only form kept of your appointment is the basic Statement Of Understanding that you will be asked to complete just before you begin.

A. Personal Information


Marital Status:

B. Family History

Identify whether your parents were strict or permissive in regard to the

C. Family Health

D. Physical Health

E. Thought Life & Emotional Health

H. Spiritual Areas

F. Lifestyle

G. Problem Areas


4. If you have not covered the basic teaching, we will usually ask you to do so before we make
an appointment.

5. I understand that my participation in completing this Confidential Personal History and in
the Freedom Appointment is totally voluntary on my part and that I am not under any
obligation whatsoever. I understand that the person who will lead me through the Steps to
Freedom is not necessarily a professional counsellor or therapist, but a fellow Christian who is
making himself/herself available to pray with me and guide me through the Steps to Freedom.
Therefore I voluntarily ask for this appointment and assume responsibility for my responses as
a result of this prayer ministry

Next Step – This Confidential Personal History has a double purpose. It is a further preparatory
step for you, by helping you focus on issues to pray about as you go through the Steps to


  1. It will also help your encourager prayerfully prepare for your appointment. But God may
    bring more issues to your mind during your appointment. Come ready to be totally open
    and honest in order to gain the greatest possible help.
  2. It is natural to sense your apprehension as you anticipate your appointment, but you will
    find an atmosphere of love and acceptance there. If you are ready to proceed, please sign
    our Statement of Understanding:


This Freedom Appointment is ran by Bianca L. Gibson, Freedom in Yeshua Ministries. You
should satisfy yourself as to our credentials, and contact us if you have any concerns about the

Declaration by the person going through the freedom appointment:

I understand this is not a counselling appointment, and that the staff of the Ministry stated
above and those associated with them, are not professional or accredited counsellors, nor
medical or psychological practitioners.

I understand that everything I share during this encouragement experience will be kept
confidential and that I alone hold the right to release any information.

However, I am also aware that if the staff of the Ministry suspect that a child (under the age of
18 years); a vulnerable adult; or an elderly person (over the age of 65 years) is currently
endangered by abuse; or if I am a danger to myself or others, they will inform the appropriate
authorities, and I give my consent to this.

I understand that I am under no financial obligation, I am here voluntarily, and am free to leave
at any time.

I deem the persons facilitating this appointment to be encouragers in the Christian faith, and
they are here to help me assume my responsibilities for finding freedom in Christ.