Conflict Resolution Inventory (#39) 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.
Children: names (optional) and ages:
Children in previous marriage: names (optional) and ages:
Were your parents believers (i.e. Christians, “born again”)?
Were your parents believers (i.e. Christians, “born again”)?
If so, did they profess and live their faith?
Were your parents divorced after you were born?
Who was the authority figure in your home?
How did your father treat your mother?
To your knowledge, was there ever an adulterous affair in your parents’ or grandparents’ relationships?
Any incestuous relationships?
Have your parents, grandparents or great-grandparents ever been involved in any occult, cultic or non-Christian religious practices?
Identify the sex and age of your sibling(s) and place yourself in birth order: (Child, Sex, Age)
Describe the emotional atmosphere in your home while you were growing up. Include a brief description of your relationship with your parents and sibling(s):
Identify whether your parents were strict or permissive in regard to the
Is there a history of ongoing physical illness in your family?
If Yes, please give specific disease(s)?
Is there a history of mental illness in your family?
If Yes, please explain briefly
Is there a history of addictive problems in your family?
Describe your general health:
Are you currently under any kind of medication for either physical or psychological reasons?
Explain: Medication Purpose
Do you have any problems sleeping?
Describe your sleeping patterns (i.e. Do you have restful sleep?). Are you having any recurring nightmares or disturbances?
E. Thought Life & Emotional Health
Please tick any of the following emotions you have had or are presently having difficulty controlling (add others if necessary);
Which of the above-listed emotions do you feel are sinful? Why?
Concerning your emotions, whether positive or negative, please indicate which of the following best describes you:
Is there someone in your life with whom you could be emotionally honest right now i.e. you could tell this person exactly how you feel about yourself, life and other people?
How important is it that we are emotionally honest before God and do you feel that you are? Explain.
Please identify any addictions or cravings that cause you difficulty in controlling your intake of sweets, drugs, alcohol, and food in general, etc.:
Please identify any moral problems you are dealing with, if any
Have you experienced severe abuse or trauma?
Describe briefly your earliest memory.
Do you have periods or blocks of time in your past that you can’t remember?
Please describe your experiences.
Do you spend much time wishing you were somebody else or fantasising that you were somebody else or possibly imagining yourself living at a different time, place or under different circumstances?
List your five favourite programmes:
What do you read most (newspaper, magazines, books, etc.) and on what topics?
What type(s) of music do you listen to, and what is the amount of time spent listening?
Would you consider yourself to be an optimist or a pessimist (i.e., do you have a tendency to see the good in people and life, or the bad?)
Have you ever thought that maybe you were “cracking up,” and do you currently fear that possibility? Explain.
Have you received Jesus Christ as your personal Saviour?
Are you plagued with doubts concerning your salvation?
How do you view God? (Distant? Harsh? Judging? Loving? Near?)
Approximately how often do you have a personal Bible reading and prayer time? When and to what extent?
Do you find prayer difficult mentally? Explain.
When attending church or other Christian ministries, are you plagued with foul thoughts, jealousies or other mental harassments? Explain.
Do you regularly attend a local church?
Are there additional ways in which you are enjoying fellowship with other Christian believers?
Why are you requesting an appointment? Please write a brief paragraph explaining why you are requesting this personal appointment to go through the Steps to Freedom in Christ.
Do you feel there is balance in your life in regard to the following areas:
Overall, is there good balance in your life?
Do you get adequate rest?
Do you get adequate physical exercise?
Do you primarily eat balanced nutritional meals?
Please make a list of the problem areas you are dealing with, including any you may have already mentioned in answering the above question. When you are finished, put a check mark by the three items you feel are your greatest areas of need.
Remember that this is confidential and you may request to have this inventory returned to you at the time of your appointment (Please don’t use explanations in answering this question, just use only one word or a simple phrase for each item on your list (e.g., anger, difficulty forgiving, depression, guilt, etc.)
MY PREPARATION FOR THE FREEDOM APPOINTMENT
1. I have read the Freedom in Christ Discipleship Series of books by Steve Goss; Free to be Yourself; Win the Daily Battle; Break Free, Stay Free; The You God Planned.
2. I have completed the Freedom in Christ Discipleship Course.
3. I have read Victory Over the Darkness and The Bondage Breaker by Dr. Neil Anderson
4. If you have not covered the basic teaching, we will usually ask you to do so before we make
Next Step – This Confidential Personal History has a double purpose. It is a further preparatory
It will also help your encourager prayerfully prepare for your appointment. But God may
It is natural to sense your apprehension as you anticipate your appointment, but you will
FREEDOM APPOINTMENT STATEMENT OF UNDERSTANDING This Freedom Appointment is ran by Bianca L. Gibson, Freedom in Yeshua Ministries. You
Declaration by the person going through the freedom appointment:
