Renewing My Relationship with God. (Check all that apply.)
            I would like to read the Bible more.
            I need help studying and understanding God's word.
            I need to allot more time for prayer.
            I would like to engage in meaningful prayer.
            I don't believe God really loves me.
            I am angry at God.
            Other. (use box below)

Renewing My Relationship with Others. (Check all that apply.)
            I am can't forgive hurts.
            I can't let go of anger.
            I am in an abusive relationship.
            I work with jerks or other troublesome people.
            I am committing adultery.
            I am jealous of others.
            I can't say NO.
            I let others control me.
            Other. (use box below)

Renewing My Relationship with Myself. (Check all that apply.)
            I hate me.
            I see myself as a loser.
            I am vain, and I know it.
            Sometimes I'm a real jerk.
            I don't think I'm attractive.
            I can't lose weight.
            I don't exercise.
            I have health issues.
            I have too many irons in the fire and am overwhelmed.
            I had an abortion.
            My life isn't working out like I had dreamed.
            I have an "addictive" personality.
            I have cravings and temptations that need controlling.
            I have unresolved issues I don't want to deal with.
            I have unresolved issues I want to resolve.
            Other. (use box below)

Renewing My Mind. (Check all that apply.)
            My mind is cluttered with dirty thoughts.
            I often have mental arguments with people.
            I am constantly criticized in my mind.
            I need an attitude adjustment.
            I am hooked on pornography.
            Other. (use box below)

Renewing My Heart. (Check all that apply.)
            I am numb and unfeeling.
            I am broken-hearted.
            I am cold toward the needs of others.
            I really don't care about anyone except myself.
            I have recently experienced divorce or a loved one's death.
            I am lonely.
            I want to be married.
            I am married but wish I wasn't.
            Other. (use box below)

Renewing My Finances. (Check all that apply.)
            I can't control my spending.
            I think about money all the time.
            I don't tithe because I can't.
            I don't tithe because I don't want to.
            I try to keep up with the Joneses.
            I am seriously in debt, and it's my fault.
            I am seriously in debt, and it's someone else's fault.
            I am seriously in debt, and it was out of my control (medical bills, loss of job, etc.)
            I gamble (or someone in my family gambles).
            I don't pay my taxes on time (or at all).
            Other. (use box below)

Renewing My House. (Check all that apply.)
            My house is a mess, and I care that it is a mess.
            My house is a mess but I don't care.
            I am a packrat.
            My car is messy, too.
            I try to clean but others in my house don't help.
            I am obsessive about cleaning. (I even drive myself crazy!)
            I am a "yard slave".
            I want to be organized but don't know where to start.
            I have a serious paper crisis.
            I have no legal affairs in order -- will, power of attorney, etc.
            Other. (use box below)