VISIT US - QUESTIONNAIRE

VISIT US QUESTIONNAIRE

ROAD MAP TO JESUS INTERNATIONAL MINISTRIES

To visit The Roadmap to Jesus International Ministry, kindly complete the questionnaire provided and submit it. Your detailed responses will help us effectively handle your request. Most communication regarding your visit will be conducted via email and WhatsApp. Please await confirmation from us before making any travel plans.

Questionnaire Form
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Name
Are you having any sickness?
Have you ever been hospitalized? If yes when?
If you are HIV positive, please indicate your status (All HIV patients need to come with their most recent original printed HIV confirmatory report when their visit is confirmed. Please note that no screening report will be accepted, only a confirmatory report that clearly states that this patient is HIV I, II OR III positive, 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.) Are you using any form of brace?
Are you using any form of walking aid (crutch, stick, etc.) or a 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 or 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 yes, please give details
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)
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