Thank you for taking our Survey

Your Name: * (need not be real name)
Your Email: * (needed to send form)
Phone: (optional)
Address: (optional)
 

                                         

Do you know for sure that you are going to Heaven?
 

                                          YES: NO:

If the answer was yes do you know why ?
                                            YES: NO:
If the answer was no would you like to know?
                                            YES: NO:
Has anyone ever told you how to get to Heaven?
                                            YES: NO:
Do you believe that Jesus Christ is the Son of God?
                                            YES: NO:
 

What do you believe about the following things?
 
  Heaven and Hell are real places.
                                             YES: NO:
  He died for us, He paid our sin debt.
                                             YES: NO:
  When we die we go to one or the other Hell or Heaven!
                                             YES: NO:
  All people are going to Heaven.
                                             YES: NO:

Which of the following do you believe?
 
  The Bible is the Word of God?
                                            YES: NO:
  There is a Heaven?
                                            YES: NO:
  There is a Hell?
                                            YES: NO:
  There is a Devil?
                                            YES: NO:

 
How often do you read the Bible?
                                        
How often do you Pray?
                                        
How often do you attend church?
                                        

 

Where do you attend when you go?
                                     
 

 
 
If you died today, do you know for sure where you would go to Heaven?
                                       YES: NO:

 

  Where would you go?
                                     
  How sure are you?
                                       

 

What makes you believe that you are going to Heaven?
 

 

If a person asked you, 'How do I get to heaven?', what would you tell them?
 

 

Has your relationship with Christ grown stronger or weaker in the last year?
 

 

How many times have you shared your faith in Jesus with someone in the last month?
 

 


 
List any prayer requests here?
 
     

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