Visit Us – S.G.F.M

Shekinah Glorious Faith Ministries welcomes visitors and partners from across the globe to stay with us and experience the power of God in Action. Shekinah is the presence of God.

FOR THOSE COMING OUTSIDE GAUTENG AND OTHER COUNTRIES:

Please fill the VISIT US FORM below. For more information please contact us at info@shekinahgfm.org:

Name *

First

Last

Gender *

Date of Birth *

Nationality

Country of Residence

Profession

Email *

Phone Number *

Relatives Name *

First

Last

Relatives Email *

Relatives Phone Number *

Are you having any sickness?

Nature of Problem *

Duration of Problem *

Any Medication *

Please include images of any medication currently taken.

How has the problem affected your life

Have you been Hospitalized ? *

Please include your medical report.

HIV Status

Are you using any form of brace?

Are you using any form of walking aid (crutch, stick, etc.) or wheelchair?

Are you using any medical device to support your health condition?

Are you limping?

Do you still go about your daily activities normally without using any aids or assistance from other people?

Can you walk normally/ climb stairs without assistance?

Do you experience body weakness?

Have you had any surgery or other therapy as a result of the problem/ condition? If so, please give details.

Is any part of your body swollen? If so, where?

Do you have any open wound? If so, where?

Are you on a special diet as a result of your sickness/ problem? If so, please state details

Do you have any other sickness or problems. If so, please list all symptoms, treatments and medications

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

How did you hear about Shekinah Glorious Faith Ministries?

Phone