Client Intake Forms (only fill out those you are asked to during initial consult)

These detailed questionnaires are necessary in order to help thoroughly examine many aspects of the client. This interview process is meant to be used when talking with the Minister assigned to a case. Some questions may seem to have come out of left field and will not make sense on the surface. The reasons behind each question are not explained to the client in the questionnaires. But please, DO NOT overthink each question; simply answer honestly. There is a method behind the madness, trust me. If you feel that you cannot be HONEST with your answers, please do not expect a full level of deliverance/healing – if any at all really. Those things that are kept HIDDEN in your heart will usually become your ultimate downfall. And, these are the places where evil hides and keeps its hold on you.

Depending on the individual case, all parts of the interview may not be used – at least, right away. Sometimes one has to put the fire out before they are able to find a cause. Each case will be triaged to determine its urgency.

The forms are provided for convenience only to give folks an idea of how we usually examine claims of demonic possession. The actual interview will be conducted by the Minister. Should you choose to fill out these forms ahead of time, the answers will be reviewed in person or over the phone prior to the start of the investigation period. Any information captured is commonly protected by the Seal of the Confessional and/or HIPAA laws.

HIPAA Notice of Privacy Practices Statement

Notice of Information Practices and Privacy Statement

For Bound No More Ministries (BNM)

How We Collect Information About You: BNM and its employees and volunteers collect data through a variety of means including but not necessarily limited to letters, phone calls, emails, voicemails, and from the submission of applications that are either required by law or necessary to process applications or other requests for assistance through our organization.

What We Do Not Do With Your Information: Information about your medical conditions and care that you provide to us in writing, via email, on the phone (including information left on voicemails), contained in or attached to applications, or directly or indirectly given to us, is held in strictest confidence.

We do not give out, exchange, barter, rent, sell, lend, or disseminate any information about applicants or clients who apply for or actually receive our services that are considered patient confidential, is restricted by law, or has been specifically restricted by a patient/client in a signed HIPAA consent form.

How We Do Use Your Information: Information is only used as is reasonably necessary to process your application or to provide you with health or counseling services which may require communication between BNM and health care providers, medical product or service providers, pharmacies, insurance companies, and other providers necessary to: verify your medical information is accurate; determine the type of medical supplies or any health care services you need including, but not limited to; or to obtain or purchase any type of medical supplies, devices, medications, insurance,

If you apply or attempt to apply to receive assistance through us and provide information with the intent or purpose of fraud or that results in either an actual crime of fraud for any reason including willful or un-willful acts of negligence whether intended or not, or in any way demonstrates or indicates attempted fraud, your non-medical information can be given to legal authorities including police, investigators, courts, and/or attorneys or other legal professionals, as well as any other information as permitted by law.

Information We Do Not Collect: We do use some affiliate programs that may or may not capture traffic date through our site. To avoid potential data capture that you visited a diabetes website simply do not click on any of our outside affiliate links.

Limited Right to Use Non-Identifying Personal Information From Biographies, Letters, Notes, and Other Sources: Any pictures, stories, letters, biographies, correspondence, or thank you notes sent to us become the exclusive property of BNM. We reserve the right to use non-identifying information about our clients (those who receive services or goods from or through us) for fundraising and promotional purposes that are directly related to our mission.

Clients will not be compensated for use of this information and no identifying information (photos, addresses, phone numbers, contact information, last names or uniquely identifiable names) will be used without client’s express advance permission.

You may specifically request that NO information be used whatsoever for promotional purposes, but you must identify any requested restrictions in writing. We respect your right to privacy and assure you no identifying information or photos that you send to us will ever be publicly used without your direct or indirect consent.