Ministry Assessment

Release of Liability for Uncaged Bird Ministries, Erica Ord and Team Members for Providing Ministry

I acknowledge that Erica Ord and team members have voluntarily agreed to pray for me. I understand that this session is not a professional counseling meeting and that none of the team members are licensed counselors. I understand that these team members are, to the best of their ability, doing what they can to help me achieve more freedom in my life.

I understand that Uncaged Bird Ministries does not charge for its services. I further state that I have voluntarily sought the assistance of my own initiative and that I am under no obligation to accept or reject any of the advice or help that I might receive from the team members of this ministry. All guidance, counsel, and advice that I receive will be based on Scriptural principles and Christian biblical standards as spelled out in the Holy Bible, the written Word of God. I further understand and acknowledge that all ministry is under the direction and control of the Holy Spirit and that no guarantees are made, nor can be made, with regard to my healing and/or freedom.

I understand that if I receive ministry from Uncaged Bird Ministries, Erica Ord and team members, the team is committed to respecting the disclosed information, but not to complete confidentiality. The information, as needed, maybe shared anonymously with other leaders of Uncaged Bird Ministries to further train leaders.

I agree to hold Uncaged Bird Ministries, Erica Ord, and all other team members free from any and all liability, loss, or damage of any kind that may arise as a result of assistance or ministry which I have received or from my involvement with Inner Healing & Deliverence Freedom Prayer Ministry.

I have read this disclaimer and release of liability. I understand and agree with it and have executed it as a free and voluntary act on my part.

NOTE: If you can't finish the form in one sitting, you can save and continue later by selecting the red button at the bottom of the form. You will then be emailed a link to continue later.



MM slash DD slash YYYY

Recommended Donation Guidelines
Ministry is free but offerings are appreciated. Donate via cash, check, or PayPal.me/ericaord, CashApp: $EricaOrd, or Venmo @Erica-Ord.

General information about receiving ministry

As you share your heart on the following pages, we assure you of confidentiality. Please be certain that you have read and understood the liability release on the previous page. Let us know if you have any concerns regarding the privacy of your information. For those requesting complete privacy, we will strike liability release language to void the clauses that allow for anonymous sharing of information in teaching. This ministry cannot be reduced to a formula by which you know that healing is complete. It is rare to heal all broken parts of a person in one multi-day ministry. This is usually because our hearts are not always emotionally ready to deal with every issue that caused a break. Please understand that some degree of follow-up may be needed within weeks or months after completing the first round of ministry to ensure complete healing.

A word about medication: Parts are typically found through our emotions. Some medications can pacify emotions enough to cause some parts to remain unfound until the medication has ceased. Consult your doctor before altering or stopping your medication for your ministry appointment. Stay in touch with your doctor if you alter usage of medication for ministry. Ministry and medical care are and should be managed as separate, non-interchangeable services. We do not provide advice concerning medical care.

Filling out the Confidential Ministry Assessment Form

The purpose of this form is to provide a profile of areas of your life in which emotional and spiritual strongholds may have been formed. This requires your complete honesty. Please be assured that you cannot tell us anything that will cause us to think less of you, scorn you, or look down upon you in any way. Honestly, it endears us to our ministry recipients. When we see problems and struggles, we rejoice in the opportunity people will have to experience God’s wonderful blessings as they are set free from these same problems and struggles.

As you fill out the form, please:

• Pray before and during your work on the form.

• Be thorough but we will cover details during your sessions. If we are missing important information, the freedom process can be made much more difficult, or even fail.

• Read the instructions for each step carefully.

• Provide the year (or your age) for all significant events that you describe.

• Tell us your story! At the end of the form, there is free space for you to write in your own words. Feel free to send us a Word document or email in place of this. It is not uncommon for people’s stories to provide us with as much or more useful information than the inventory form itself! Please tell us:

• About the major events of your life that caused you hurt, difficulties, trauma, or great disappointment.

• How these events made you think and feel about yourself.

• How old you were when each event occurred.

• How you feel about yourself now, and why you are seeking freedom ministry.

Remember, more information is better. If in doubt about whether you should include something, please do.

This form must be sent to our team at least a week prior to your first ministry session. You can also mail the form to 5140 Galleria Cove, Conway, AR 72034, or provide us with a very legible scanned copy via email to uncagedbirdministries@yahoo.com. We reserve the right to reschedule appointments when forms are incomplete or not received before the scheduled session.

Call or email us if you have questions: uncagedbirdministires@yahoo.com or call or text 501.231.9817.

CONFIDENTIAL PERSONAL INVENTORY

PERSONAL INFORMATION

Name
MM slash DD slash YYYY
Place of birth
Address
MM slash DD slash YYYY

VIDEO MINISTRY INFORMATION

REASON(S) FOR SEEKING MINISTRY

SALVATION

IDENTITY

RELATIONSHIP WITH GOD

CHILDHOOD

RELATIONSHIP WITH SPOUSE/CHILDREN

If you are not married, please skip this section.

ADDICTIONS

MENTAL & EMOTIONAL HEALTH

16. Please state below, under “Earliest Age” the earliest age you struggled with any of these subjects, and an X under “Present” if you still struggle with any of them:

Daydreaming
Earliest Age
Present
 
Worry
Earliest Age
Present
 
Thoughts of inferiority
Earliest Age
Present
 
Thoughts of inadequacy
Earliest Age
Present
 
Insecurity
Earliest Age
Present
 
Compulsive thoughts
Earliest Age
Present
 
Headaches
Earliest Age
Present
 
Apathy
Earliest Age
Present
 
Lustful thoughts
Earliest Age
Present
 
Fantasizing
Earliest Age
Present
 
Doubts
Earliest Age
Present
 
Obsessive thoughts
Earliest Age
Present
 
Blasphemous thoughts
Earliest Age
Present
 
Dizziness
Earliest Age
Present
 
Skepticism
Earliest Age
Present
 
Hardness in emotions
Earliest Age
Present
 

17. Please state below under “Earliest Age,” the earliest age you remember strong, prolonged fear to any of the following, and make an X under “Present” if you still do:

Failure
Earliest Age
Present
 
Authority figures
Earliest Age
Present
 
Rape
Earliest Age
Present
 
Satan and evil spirits
Earliest Age
Present
 
Insanity
Earliest Age
Present
 
Opinions of people
Earliest Age
Present
 
Enclosed spaces
Earliest Age
Present
 
Open spaces
Earliest Age
Present
 
Crossing bridges
Earliest Age
Present
 
Insects
Earliest Age
Present
 
Snakes
Earliest Age
Present
 
Pain
Earliest Age
Present
 
Being alone
Earliest Age
Present
 
Water/swimming
Earliest Age
Present
 
Women
Earliest Age
Present
 
Men
Earliest Age
Present
 
Flying in an airplane/etc
Earliest Age
Present
 
Inability to cope
Earliest Age
Present
 
The dark
Earliest Age
Present
 
Violence
Earliest Age
Present
 
The future
Earliest Age
Present
 
Public speaking
Earliest Age
Present
 
Old age
Earliest Age
Present
 
Terminal illnesses
Earliest Age
Present
 
Spiders
Earliest Age
Present
 
Animals
Earliest Age
Present
 
Loud noises
Earliest Age
Present
 
Grocery stores/malls
Earliest Age
Present
 
Death
Earliest Age
Present
 
Death or injury of loved one
Earliest Age
Present
 
Accidents
Earliest Age
Present
 
Divorce or marriage break-up
Earliest Age
Present
 
Other
Earliest Age
Present
 

18. Please state below under “Earliest Age,” the earliest age you remember having any behavioral patterns with the following subjects, and make an X under “Present,” if you still do:

Impatience
Earliest Age
Present
 
Temper
Earliest Age
Present
 
Legalism
Earliest Age
Present
 
Rebellion
Earliest Age
Present
 
Anti-Semitism
Earliest Age
Present
 
Stubbornness
Earliest Age
Present
 
Vengeance
Earliest Age
Present
 
Manipulation
Earliest Age
Present
 
Irritability
Earliest Age
Present
 
Racial prejudice
Earliest Age
Present
 
Moodiness
Earliest Age
Present
 
Violence
Earliest Age
Present
 
Religious pride
Earliest Age
Present
 
Grudge-holder
Earliest Age
Present
 
Intimidator
Earliest Age
Present
 
Self-centered
Earliest Age
Present
 

19. State below, under “Earliest Age” the earliest age you remember experiencing difficulty in controlling any of the following emotions and an X under “Present” if you still struggle with controlling those emotions:

Frustration
Earliest Age
Present
 
Anger
Earliest Age
Present
 
Anxiety
Earliest Age
Present
 
Loneliness
Earliest Age
Present
 
Worthlessness
Earliest Age
Present
 
Hatred (for self)
Earliest Age
Present
 
Hatred (for others)
Earliest Age
Present
 
Bitterness
Earliest Age
Present
 
Depression
Earliest Age
Present
 
Fear of losing your mind
Earliest Age
Present
 
Fear of committing suicide
Earliest Age
Present
 
Fear of hurting loved ones
Earliest Age
Present
 
Fear of death
Earliest Age
Present
 
Fear of _________
Earliest Age
Present
 

RELIGIOUS CULT HISTORY

5. Please mark any activities below that you or your relatives have ever been involved in. Initial where applicable with: S = Self, F = Family member.

Freemasonry
Eastern Star
Daughters of Eastern Star
Job’s Daughters
Boys Order of DeMolay
Shriners
Rainbow Girls
Moose Lodge
Elks Lodge
Ouija board
Satanism
Theosophical Society
Witchcraft
Fortune-telling
Tarot cards
Palm-reading
Black or White Magic
Automatic writing
Table-lifting/Light as a feather
Bloody Mary
Enneagram
Druids
Rosicrucian
Zen Buddhism
Hare Krishna
Mormonism
Jehovah’s Witness
Unification Church
Christian Science
Scientology
Unitarianism
Astrology
New Age
Islam
H.W. Armstrong (World Wide Church of God)
Astral projection
Seance
Dowsing/Water witching
Yoga

ABUSE & SEXUAL HISTORY

LIES ABOUT SELF AND NEGATIVE MINDSETS

Check each statement that describes your thinking about yourself

INNER VOWS

Please check anything in the list below that reflects a spoken or unspoken mindset, statement, or attitude that you feel characterized your thinking at any time past or present.

Please tell us about key events that may have had a negative or traumatic effect on your life.


You can type in the box provided below or you can upload a document below.
All information is kept confidential according to the liability release.
Accepted file types: jpg, pdf, , Max. file size: 128 MB.

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