Visitor's Questionnaire

The DiVineyard Church Of His Presence welcomes visitors from all over the world to witness the power of God Almighty working through the Holy Spirit, by His Word. Many people travel from across the globe to witness the mighty power of Jesus Christ and receive a touch from heaven, through his servant John Chibwe.

For all international visitors who would like to visit The DiVineyard Church Of His Presence, please complete the form below and wait for confirmation before coming.

Personal Information

Please provide your basic personal details

First Name

Last Name

Passport Number

Language(s)

Type each language and press Enter or use comma to separate

Phone Number

Phone Number 2

Gender

Age

Occupation

Country of Residence

Nationality

Next of Kin Information

Emergency contact details

Next of Kin

Next of Kin Phone

Next of Kin Email

Health Information

Please provide details about your health condition

Are you having any sickness?

Are you having any spiritual problems?

How has the problem/ condition affected your daily living?

Have you ever been hospitalized? If so when?

If you are HIV positive, please indicate your status:

*All HIV patients should bring their most recent original medical results when their visit is confirmed. Please note that only a confirmatory report clearly indicating that the patient is HIV I, II OR III positive is required and it must be typed on the hospital's letterhead. It must be a government recognized hospital in your country. You cannot come without the correct medical report.

Physical Condition

Information about your physical abilities and condition

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? If so, please state details:

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

Visit Information

Details about your planned visit

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 additional information section that they intend to come with you)

How did you hear about The DiVineyard Church Of His Presence?

Additional information (Please state the period/month you intend to visit):

Please be as detailed as possible to help us prepare for your visit