PIF Adult 4 Religious Information Do you believe in God? Yes No Uncertain Have you come to a place in your spiritual life where you know for certain that if you were to die today you would go to heaven? Yes No Uncertain Suppose you died today, and God asked you: “Why should I let you into my heaven?” What would you say? Have you been baptized? Yes No How would you describe what God is like? Number of days you read the Bible in any given week: 01234567 How often do you pray to God? Rarely Occasionally Daily What do you pray for? Explain any recent changes in your spiritual life, if any: Religious background of spouse: Denominational preference: Church attended in childhood: City/State: Name of church you attend: City/State: Who is your pastor? Do you have any other leaders in your church? (List their names and positions): Do you consider yourself to be spiritually accountable to anyone? Who? Have you spoken with anyone in your church leadership regarding the topic(s) that bring you to counseling here? If so, please list their name(s) and position(s) in your church: Number of church services you attend per month: 012345678910+ If you are human, leave this field blank. Submit
