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Prior Marriages? If so, how many?:

Names of Children:

Where and approximately what age?

Name of current church: (put None if needed)

How did you hear about this ministry?

The purpose of this form is to help determine possible entry ways for evil spirits...obviously, generational/ancestral permission as forewarned in Exodus 20:5 is a possibility in anyone's life. There are 30 ancestors in your history that could have passed a spirit on to you, likely, you only know about your parents and each of their two parents.

Please give any information that the Holy Spirit brings to your mind. Examples would be involvement with the occult, sexual perversion, alcoholism, depression or mental disorders, lots of divorce, adultery, anger, criminal activity, births out of wedlock, involvement in groups such as Masonry, Eastern Star, Rainbow Girls, Oddfellows and Rebecca Lodge etc. Aware of ancestor involvement in any of these? If yes, explain:

Note: It is not necessary to go into detail with any of your responses. Ask the Holy Spirit to show you any area of concern.

From birth and your early childhood: Trauma during pregnancy by your mom or dad, divorce, words of "We shouldn't be having this child", etc.? If Yes, explain:

Early childhood fears, injuries, nightmares, see things in your room, felt evil presence? If Yes, explain:

Any sexual abuse, or sexual embarrassment through childhood? If Yes, explain:

Spoken words from parents, or others that were condemnation: "You're fat, you're stupid, you'll never amount to anything, you always mess up, I don't know why we had you. You can't be in our group". etc. Or embarrassing or humiliating experiences at school or from school teacher? If yes, explain:

Any physical abuse from parents or others? If Yes, explain:

Involvement (however innocently it may have been) with Ouija Boards, Magic 8 Ball, levitation games, seances, fortune tellers, tarot cards, astrology, horoscopes, fascination with books about magic, physics seers, Harry Potter books, Pokemon cards, etc.? If Yes, explain:

Please list accidents or injuries that come to your mind as being frightening to you at the time:

Please list surgeries and approximate age:

Movies or TV programs that were particularly frightening to you, or specific scenes that seem to stick in your memory:

Have you participated in pre-marital sex?: (This has to do with identifying soul ties that can cause lingering attachment and unwanted negative effects left over by that relationship

Periods of immorality? If Yes, explain and specify ages:

Drinking and/or drug use? If Yes, explain and specify ages:

Do you experience unusual fears? If Yes, explain:

What do you think may be the areas of demonic influence in your life?:

Problems in home? If Yes, explain:

Are your parent's divorced? If Yes, how old were you?:

Unusual feelings such as: Never really felt loved, couldn't please my father/mother, feelings of worthlessness, etc.? If Yes, explain:

Exposed to pornography? If Yes, how old were you?:

Do you have any objects in your home or possession that relate to ungodliness or cults, this would include new age religions, such as books about eastern deities, crystals, heavy metal music, Native American artifacts, wiccan, etc.? If Yes, can you give examples?:

Ever "felt" a presence in the room? If Yes, has it been recently?:

If either question was Yes, please give an example.

Have you been diagnosed by a doctor as having: (list any diagnosis, diabetes, asthma hypertension, etc.)? If Yes, list the diagnosis here:

Do you have inexplicable pain...no medical explanation for it? If Yes, please explain:

Do you have difficulty in trusting others? If Yes, do you know why? Please explain:

Has there been a death of someone close to you? If so, whom?:

Do you feel like you have any eating disorders? If Yes, do you know when they begin? Please give approximate height and weight:

Do you suffer from sleep disorders?:

Any other medically defined disorder? If Yes, please explain:

Is there a history of tuberculosis, diabetes, ulcers, cancer, heart disease, glandular problems, asthma, other in your family? If Yes, please explain:

Did you have imaginary friends as a child? If Yes, what were their names:

If Yes, when did they begin?:

Insecurity? (On a scale of 1-10 with 10 being worst)? Please explain:

Prayer Form