Adult Secondary Intake

  • You are here
  • Home
  • Adult Secondary Intake

Adult Secondary Intake Form

Hope for Wholeness and all of our leaders commit to keep all of your information CONFIDENTIAL.

This is the second of two intake documents. Prior to this one is the HFW Participant Application that is required for a first time appointment. If you have not completed this form first, please go back and do so. This one is necessary for us to help you further, but is not necessary for a first time appointment.

This information is highly personal in nature. You may or may not have difficulty answering the questions that follow. It is not our desire to invade your privacy; however these are all questions that we feel we need to know, to better help and pray for you. We have found it easier for you to complete this, rather than to answer these questions verbally and cause possible embarrassment. Just because something is in the past does not mean that it has been dealt with. If filling out any of these questions makes you uncomfortable, and/or you do not want us to know some things, then simply complete what you are able. We can only help you to the depth that you are willing to share. Regardless, we want to get to know you and help you. Please be sure to spend some time in prayer before and after completing this questionnaire, as it may bring up painful elements from your past.

Even if you have spoken to a leader, please write your answers and details as having never spoken to anyone. This will help us in our care for you now and in the future.

HFW Adult Secondary Intake form

    Sexual or relational encounter means any type of behavior with someone that is inordinate (past appropriate boundaries of normal moral standards). This could express itself in many ways, but is much more than merely intercourse. This behavior could express itself in a homosexual emotional relationship, kissing, inappropriate talk, internet chatting (inappropriate communication), touching, watching pornography together, watching someone acting inappropriately (not necessarily to participate), mutual masturbation, oral sex, and more.
  • Marital Section

    If not married, you have completed the form.
  • Copy/Paste and/or Print

    Be SURE to copy/paste and/or print your form BEFORE hitting submit to ensure that your form is saved before transmitting. You should also keep a copy for your own files.


malware removal and website security SSL Cerficate