Life Evaluation Form

This is a way of searching events, personal interactions and forgotten or repressed issues from our past, bringing them to the present and allowing us to process them.  This sometimes isn’t a pleasant experience.  This can even seem to worsen the issue.  However, if you remain connected with God and give him all the situations that arise, He will help see you through.  You do not have to process the entire form all at one time.  You might need to take several days to complete this.  Work on it in your own timing.  As you submit your forms, we will review them and see if there are areas we can reach out to assist you with.  Please remain connected with us during this time and stay accountable to your accountability partners.

I suggest that before you start, that you make a couple follow up appointments to talk over and share your experiences.  That link is in the bottom right hand corner of this page.

Remember… ALL information is kept at the strictest of confidence.

Duty to Warn:

Restored Warriors is Obligated to Inform Law Enforcement IF:
  1. Any information leading to suspicion or knowledge of the physical or sexual abuse or neglect of a minor child.
  2. Any information leading to suspicion of knowledge of danger to a third party.
  3. Any information leading to suspicion or knowledge of suicide of a client.

Personal Information:

Emergency Contact Information

Marital Status


If you have children, please complete the next section.

(Unlimited space)

Present Living Situation


Your Involvement at Restored Warriors

(Unlimited Space)

Employment & Income

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