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Spiritual Assessment Form
Date picker
First name
Last name
Multi-line address
Country/Region
Address
City
Zip / Postal code
Phone
Email
The most important relationships in my life include:
My family of origin (parents, siblings, ect.)
A significant other or spouse
Children
Spouse
God or a higher power
Coworkers
Other
What helps you cope in difficult times?
Support of family/friends
Belief in the basic goodness of life
Faith in God/Higher Power
Music/Poetry/Literature
Prayer/Meditation
Other
Who or what helps you find meaning or a sense of purpose?
Family relationships
Friendships
Work
God or a higher power
Other
How do you take care of yourself?
Time alone
Talking to others
Physical exercise/diet
Prayer/meditation/other ritual
Nothing
Other
Do you believe in God or a higher power?
Yes
Somewhat
No
If yes, how would you describe God/your higher power?
Angry
In control of all events
Judging
All-Knowing
Able to do anything
Loving
Merciful
Gracious
Other
If no, what are your beliefs about life?
Random events
Hopeless
Disgruntle
Frustrated
Lacking Emotion/Feeling
Numb
Other
Are there any practices that are important to you?
Attending religious services
Prayer
Reading scriptures
Meditation
Yoga
Community events
Other
What areas of your spiritual life are you most concerned about, if any?
Are you interested in spiritual counseling or mentorship?
Yes
No
Not sure
Do you attend a local/online church?
Yes
No
Tell us a bit about your spiritual background.
Use this space to share anything you would like to share about your spiritual needs.
Use this space to testify of the good things God has done in your life.
Submit
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