NewConHelpForm

SCV Confidentual Help Request Form

Use this Confidential Help Request Form if you or a loved one are having some kind of trouble with the paranormal. Please be as clear as you can when describing what is happening and what you have attempted to do about it. All information including e-mail address is confidential and will not be shared with anyone other than the SCV ministry team. Once you have completed this form, return to the blog and check the help request log on the right side column for an update. Please click on the Submit button only once and when you do you will be returned to the blog.

Full Name

Country

Street Address

City

State

Zip

Email

Confirm

Age

Gender (Check One)

Male Female

Spiritual Information

Are you a Christian

Yes No

If you are not a Christian, what religion are you (if any)?

Have you been Baptized in water?

Yes No

Please check one.

Have been Baptized in the Holy Spirit and speak in tongues?

Yes No

What is your denomination or fellowship?

How often do you attend Church?

Medical Information

If you have had mental problems, what are they?

Are you taking any drugs, if so list them please.

Paranormal Information

Do you think you are sensitive to spirits?

Yes No Don't Know

Has someone in your family been a psychic or medium?

Yes No Don"t know

In the next two boxes, describe any involvement you had with the occult. For example have you used an ouija board or gone to a psychic? In the following box tell me what where the results of your experience. Please be detailed in your description!

My involvement with the occult (if any).

You are limited to 10,000 characters - so keep it to the point.

The results of my involvemenat have been (if any).

You are limited to 10,000 characters - so keep it to the point.

In the first of the next two boxes, tell me about the paranormal problem which you or a love one are dealing with presently. Then in the next box tell me what you have done to correct the problem.

The problem is:

You are limited to 10000 characters - so keep it to the point.

This is how I have tried to solve the problem.

You are limited to 10000 characters - so keep it to the point,

Do you want us to send you a Prayer Cloth?

Yes No

Please enter the two words you see in the box. If you can not read them and want other words press the top right button. If you want to hear the words press the button with the speaker. If you need help press the button with the question mark. When you have finished entering the words press the submit button and you will be taken back to the blog.