Here is questionnaire for the visit us form: Please, let us know your personal information: Full name(Required) Age(Required)Gender(Required) Male Female Profession(Required) Nationality(Required) Your Phone Number(Required) Your Email Address(Required) Country of Residence(Required) Kindly, state your main reason for visiting the Ark of God's Covenant Ministry.(Required)Do you have any health problem, physical ailments or disabilities? If so, state the nature and all the symptoms.(Required)For how long have you been experiencing this problem?(Required)List all the medications you are taking/ have taken due to this problem/ condition:(Required)How has the problem/ condition affected your daily living?(Required)Have you ever been hospitalized? If so when?(Required)Do you experience excessive body weakness? Do you have to lie down most of the time?(Required)How did you hear about The Ark of God's Covenant Ministry?(Required)Are you pregnant? If so, how many months? (If applicable)Do you have any eye or ear problem?(Required)Can you walk and climb stairs normally without assistance from people or the use of a walking aid?(Required)Do you intend to come alone or accompanied?(Required)(If you will be accompanied, please ask each of those with you to also submit this questionnaire, indicating their willingness to come with you in the comments section). Quick Contacts CAMSIC Junction, Buea South West Region, Cameroon. +237 671 715 031 +237 672 944 216 info@johnchi.org contacts You want to be a part of us? Contact Us.
