Home
About
Deliverance
Testimonials
Donate

Home
About
Deliverance
Testimonials
Donate

Name*

Age

Address

Phone

Email*

Spouse's name, if married

Names and ages of children, if any

Father's last name and mother's last (maiden) name

Age you were saved

Name of current church

To the best of your knowledge, were your ancestors involved in the occult, criminal activity, or sexual perversion? Do any addictions or mental disorders run in the family? Is there a family history of adultery, divorce, or births out of wedlock? Describe.

Do you feel rejected, abandoned, or worthless?

Yes

Do you have extreme anger?

Yes

Do you have anxiety?

Yes

Are you depressed? Do you have thoughts of suicide? A desire to self-harm? If yes, please provide details.

Do you have difficulty focusing? Do you struggle to read and retain God’s word? Do you have a diagnosis of ADD, ADHD, or OCD? If yes, please provide details.

Do you have a tendency to lie or believe lies?

Yes

Do you have difficulty forgiving?

Yes

Do you struggle with unbelief?

Yes

Do you have intrusive blasphemous thoughts?

Yes

Have you experienced unusual fears or nightmares? Have you felt an evil presence? Do you hear voices? If yes, please provide details.

Please describe any trauma you have experienced, including abuse of any kind (verbal, physical, sexual, emotional, or spiritual).

Please list any addictions you have struggled with (such as drugs, alcohol, smoking, p*rn, gambling, etc.)

Do you struggle with lust, masturbation, or homosexual tendencies? Any compulsive sexual sins? If yes, please provide details.

Have you been involved in the occult or witchcraft in any way? If yes, please provide details.

Do you have pain without a medical explanation?

Yes

Do you have any eating disorders? Any sleeping disorders? Other mental health disorders? If yes, please provide details.

Do you have any of the following: arthritis, asthma, barrenness, cancer, fibromyalgia, heart disease, hypertension, migraines, miscarriages, or family history of premature death?

Are you water-baptized? Water baptism is necessary before deliverance!*

Yes

Apply for Deliverance

Please complete this form before scheduling an appointment.

All information is confidential--for your deliverance session only.

Yes, we know the form is long. Thank you for your detailed response!

Contact

setfreechristian@gmail.com