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Name *

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Date *

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Gender *

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Age *

Marital Status *

Nationality *

Occupation *

Phone *

Email

Residential Address *

Town/City *

Region/County *

Country/State *

Religion *

Name of Local Church *

Are You Born Again? *

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Do you have any sickness? *

Yes
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If Yes, please specify

Please state the nature of your problem you want us to help you with *

For how long have you been experiencing this problem? *

Any other detail you would want us to know with regards to your problem

(Hospitalization, Medication, Challenges etc.)

Have you had counselling before? *

Yes
No

If Yes, where and when?

How did you hear of Salvation Clinic International Ministries *

Do you intend to come alone or accompanied? (If you will be accompanied, please ask each of those with you to also submit this form, indicating in the comments section that they intend to come with you) *

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Comments

Telephone:
(+233) 057 148 8211 (Ghana)

(+44) 786 350 0036 (UK)

Church Time:

Day Service Time

Gh | UK

Monday Evening Reflection 19:00 | 20:00

Tuesday E-Teaching Service 19:00 | 20:00

Wednesday Meditation 19:00 | 20:00

Mon. to Fri. B4 Day-Break Prayers 05:00 | 06:00

Sunday E-Anointing Service 09:00 | 10:00

Sunday E-Rhema Service 19:00 | 20:00

Address:
Haatso-Bohye, Accra, Ghana

SCIM PASTORS
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