Form 2 - Occult Checklist Review

E-mail Address: *

Your First and Last Name - - make sure you fill or check every question or form will not go through. Also, You are under demonic attack and wonder why you had to fill out the other form. It is all related. A curse causeless cannot come according to Prov. 26:2. I look for open doors. Most diseases also have a spiritual root cause. *

When reading the word, do you have a hard time staying awake or listening to the word in church and does your mind wonder? *

Yes
No

While attending church or other Christian ministries, are you plagued with foul thoughts, jealousies or mental harassments? *

Yes
No

Do you feel a band around your head? *

Yes
No

Do you suffer from confusion 50% of the time? *

Yes
No

Do you suffer from oppression 50% of the time? *

Yes
No

Do you have fainting spells? *

Yes
No

Do you suffer from pain that seems to move in your body? *

Yes
No

Do you have seizures? *

Yes
No

Do you suffer from abnormal fears or panic attacks? *

Yes
No

Do you experience loss of time an hour or more and not remembering what happened during that time? *

Yes
No

That first memory was it bad or good? *

Yes
No

What is your earliest memory from childhood? *

Believed in Astrology for your future *

Yes, I still believe in Astrology
No, I gave it up
Somewhat believe in it
Not sure
My Parents are still into astrology

Believed and read Horoscopes for your future *

Yes
Ancesters
Both
No

Believed in Zodiac Signs for your future *

Yes
Ancestors
Both
No

PLEASE DO NOT SKIP ANY QUESTIONS: Magical Amulets for protection: Acorn, Agate, Agate, Cross Alligator Teeth, Ankh, Eye of Horus, Fetish, Fox Tail, Four Leaf Clover, Hexagram, Horn of Plenty, Horseshoe, Knot, Magic Triangle, Jupiter, Mezuzah, Evil Eye Stone, Evil Eye Stone, Ra, Scarab, Star, Sun, Tassel, Turtle, Planets *

Yes
Ancestors
Both
No

Practiced Black Magic *

Yes
Ancestors
Both
No

Had Tarot Cards Read by Someone *

Yes
Ancestors
Both
N/A

I did the Spinning Knife *

Yes
Ancestors
Both
N/A

Went to a Psalmist and had your palms read *

Yes
Ancestors
Both
N/A
I read other peoples Palms

Graphology *

Yes
Ancestors
Both
No

Someone did Rod, Tea Leaf Reading to Determine the Sex of My Child *

Yes
Ancestors
Both
No

Unscriptural Dream Interpretation by Edgar Casey *

Yes
Ancestors
Both
No

Owned Crystal Ball for Fortune Telling or Went to a Fortune Teller who Read the Cyrstal Ball *

Yes
Ancestors Only
Both
No

Pyramidology (mystic powers) *

Yes
Ancestors
Both
No

Owned 8 Ball For Determining Future *

Yes
Ancestors
Both
No

Past Life Reading *

Yes
Ancestors
Both
No

Coffee Cup Reading by Someone *

Yes
Ancestors
Both
No

Character Analysis Done *

Yes
Ancestors
Both
No

Had Arura Readings Done *

Yes
Ancestors
Both
No

Had Done a Feng Shui Reading *

Yes
Ancestors
Both
No

Reading Intestines *

Yes
Ancestors
Both
No

Had Wedding cake under pillow *

Yes
Ancestors
Both
No

Done Throwing the Bones (Doles) *

Yes
Ancestors
Both
No

Gone to a hypnotist *

Yes
Ancestors
Both
No

Gone to a seance *

Yes
Ancestors
Both
No

During Seance Demons Appeared or Spoke Through Someone *

Yes
Ancestors
Both
No

Trumpet Spirit Speaking *

Yes
Ancestors
Both
No

Apport paranormal transportation (objects appear in the air) *

Yes
Ancestors
Both
No

Spirit rapping *

Yes
Ancestors
Both
No

Spirit photography *

Yes
Ancestors
Both
No

Prayed or Talked to the Dead - Necromancy *

Yes
Ancestors
Both
No

Table tipping or table rapping *

Yes
Ancestors
Both
N/A

Had Imaginary friends and/or escape escorts *

Yes
Ancestors
Both
No

Practiced Automatic Writing or Art *

Yes
Ancestors
Both
No

Playing with the glass *

Yes
Ancestors
Both
No

Invited Spirit Guides In as Helpers *

Yes
Ancestors
Both
No

Invited Ascended Masters For Guidance *

Yes
Ancestors
Both
No

Played with ouija board *

Yes
Ancestors
Both
No

Done Divining or Roding To Find Water or Money *

Yes
Ancestors
Both
No

Consultation with a psychic healer *

Yes
Ancestors
Both
No

Practiced Telekinesis (allowing objects to move to stop) *

Yes
Ancestors
Both
No

Consulting with a medium *

Yes
Ancestors
Both
No

Consultation with a familiar Spirit(s) *

Yes
Ancestors
Both
N/A

Problems with Poltergeists In The Home *

Yes
Ancestors
Both
No

Having Problems With Astral Projection Coming Into The House *

Yes
Ancestors
Both
No

Believe or Used To Belief in Reincarnation (including deja vu experiences) *

Yes
Ancestors
Both
No

Personally Done Astral travel (Eccles 2:6, silver cord) *

Yes
Ancestors
Both
No

Psychic experiences or gifts (reading minds of others) *

Yes
Ancestors
Both
No

Experience Psychic phenomena

Yes
Ancestors
Both
No

Paranormal experiences

Yes
Ancestors
Both
No

Psychokinesis Ability (lighting fire, fusing light bulbs) *

Yes
Ancestors
Both
No

Went to a Non Christian Exorcism *

Yes
Ancestors
Both
No

Levitation (person moving above ground) or game known a *

yes
Ancestors
Both
No

Had Smudging to do cleansing of evil spirit *

Yes
Ancestors
Both
No

Done Evil Eye (breaking egg and putting it under the crib) *

Yes
Ancestors
Both
No

Reading Related Literature (Edgar Cayce, Lobsang Rampa, Allister Crowley, Manley Hall, Jean Dixon, Nostradamus) *

Yes
Ancestors
Both
N/A

PLEASE DO NOT SKIP ANY QUESTIONS OR FORM WILL NOT GO THROUGH: EXTRA SENSORY PERCEPTION SECTION - Clairvoyance/precognition *

Yes
Ancestors
Both
No

Gone to Parapsychology or Studied Parapsychology *

Yes
Ancestors
Both
No

Done Voodoo, Hoodoo, Ooodoo on Others *

Yes
Ancestors
Both
No

Practiced Eastern Meditation *

yes
Ancestors
Both
No

Done Past Life Therapy *

Yes
Ancestors
Both
No

Practiced Teleportation *

Yes
Ancestors
Both
No

Feel Someone Doing Voodoo Against You *

Yes
Ancestors
Both
No

Gone to a Chiromancy Practicioner *

Yes
Ancestors
Both
No

Gone to Phrenology Practictioner *

Yes
Ancestors
Both
No

Practiced Visualization To Determine Your Future *

Yes
Ancestors
Both
No

Used Healing Magnets *

Yes
Ancestors
Both
No

Had Clairaudience Done (irrational diagnosis of illness crystal ball gazing) *

Yes
Ancestors
Both
No

Had someone Interpreting/Reading Auras *

Yes
Ancestors
Both
No

Witchcraft Practice on Others (spells, etc.) *

Yes
Ancestors
Both
No

practiced Numerology *

Yes
Ancestors
Both
No

Believe in Vedic Philosophy *

Yes
Ancestors
Both
No

Had Done Biorhythm Charts *

Yes
Ancestors
Both
No

Done Demonic glossolalia ecstatic tongues *

Yes
Ancestors
Both
No

Done ransference is a phenomenon characterized by unconscious redirection of feelings from one person to another *

Yes
Ancestors
Both
No

Mental Telepathy (knowing another's thoughts) *

Yes
Ancestors
Both
N/A

Seeing into or through *

Yes
Ancestors
Both
N/A

Drug Trips to See Demons *

Yes
Ancestors
Both
N/A

Gone to Inner Healing Ministry (Calling Jesus into your memory) *

Yes
Ancestors
Both
No

Practiced Fire Walking *

Yes
Ancestors
Both
No

Going to False Prophets *

Yes
Ancestors
Both
No

Visionary dreams or prophetic insight not from Holy Spirit *

Yes
Ancestors
Both
No

Practice Geomancy Interpreting lines or textures on the ground *

Yes
Ancestors
Both
No

Multilocation - being in multiple places at the same time *

Yes
Ancestors
Both
N/A

Practiced Shape Shifting *

Yes
Ancestors
Both
No

Practiced Reading Cards *

Yes
Ancestors
Both
No

Psychoscopy - Obtaining information about a person or object *

Yes
Ancestors
Both
N/A

Comments

Occult/Non-Christian Religious Literature: Carols Casaneda *

Yes
Ancestors
Both
N/A

Reading of Necronomicon Literature *

Yes
Ancestors
Both
No

Read or have satanic Bible *

Yes
Ancestors
Both
No

Member, Studied or have book of Mormon *

Yes
Ancestors
Both
No

Reading teachings of Buddha or was a buddha follower *

Yes
Ancestors
Both
No

Believe, Owned or studied The Koran

Yes
Ancestors
Both
No

Own and studied Course of Miracles *

Yes
Ancestors
Both
No

Own and/or studied the Urantia Book *

Yes
Ancestor
Both
No

Own and/or studied Bhagavad-Gita *

Yes
Ancestors
Both
N/A

Own and/or studied the Book of the Dead *

Yes
Ancestors
Both
No

Own or studied the doctrines & Morals & Dogma (Pike) - Freemasonry *

Yes
Ancestors
Both
No

Own and/or studied Dianetics *

Yes
Ancestors
Both
No

Own and/or studied upanishads *

Yes
Ancestors
Both
No

Been a follower, Own and/or studied New Ageology *

Yes
Ancestors
Both
No

Own and/or studied on book of spells, and/or sent witchcraft curses on others *

Yes
Ancestors
Both
No

Follower, Own and/or studied Nazism *

Yes
Ancestors
Both
No

Feel As Though Someone Cursing You With Witchcraft Curses *

Yes
Ancestors
Both
No

Been Part of Church of Satan *

Yes
Ancestors
Both
No

Been a follower, studied or own book of Jehovah's Witness *

Yes
Ancestors
Both
No

Been part of Children of God *

Yes
Ancestors
Both
No

A follower of Christian Science *

Yes
Ancestors
Both
No

Worshipped Santeria *

Yes
Ancestors
Both
No

Been a follower, studied Scientology *

Yes
Ancestors
Both
No

Been a follower of Swedenborgianism *

Yes
Ancestors
Both
No

A follower of Islam / Hinduism, own Koran, Studied the religion *

Yes
Ancestors
Both
No

Been a follower Rosicrucian's *

Yes
Ancestors
Both
No

A follower of Hare Krishna *

Yes
Ancestors
Both
No

A follower of Unity Church *

Yes
Ancestors
Both
No

Studied and follower of Theosophy *

Yes
Ancestors
Both
No

A follower of The Way International *

Yes
Ancestors
Both
No

A follower and study of Zen *

Yes
Ancestors
Both
No

Believe in Mythology *

Yes
Ancestors
Both
No

Science of the Mind *

Yes
Ancestors
Both
N/A

Been to an Eckankar retreat *

Yes
Ancestors
Both
No

Studied Kabbalism *

Yes
Ancestors
Both
No

Gone to a Shamanism (Medicine Man) or Wizard *

Yes
Ancestors
Both
No

A follower of Rastafarianism *

Yes
Ancestors
Both
No

A follower of Bahaism *

Yes
Ancestors
Both
No

Been into Satanism *

Yes
Ancestors
Both
No

Been part of the Unification Church *

Yes
Ancestors
Both
No

Been Part of The Church Universal *

Yes
Ancestors
Both
No

Practiced Unbanda/Macumba/Condombles Voodoo *

Yes
Ancestors
Both
No

Studied and Believed Taoism *

Yes
Ancestors
Both
No

Devotion to Swamis/Gurus/Witch Doctor *

Yes
Ancestors
Both
No

Part of and Studied and believed in Gnostism *

Yes
Ancestors
Both
No

Worship of Mother Earth / Gaia / New Thought *

Yes
Ancestors
Both
No

Been part of the Moonies and practiced Transcendental Meditation *

Yes
Ancestors
Both
No

Beleive in Chrislam *

Yes
Ancestors
Both
No

Believe in Death and Dying Movement *

Yes
Ancestors
Both
No

MYSTISM SECTION: Seeing Demons / Hearing Demons *

Yes
Ancestors
Both
N/A

I Have Demons Tormenting Me or Parents Had That Problem *

Yes
Ancestors
Both
No

I had Sex with demons (spiritual spouse - marine spirits) *

Yes
Ancestors
Both
No

Sex demons incubus and succubus bothering and touching in the night *

Yes
Ancestors
Both
No

Practiced Sex Magic *

Yes
Ancestors
Both
No

Sex with demons purposely as initiation *

Yes
Ancestors
Both
N/A

Purposely did Transcendental Meditation or Altered state of consciousness) to emptying mind to move up higher *

Yes
Ancestors
Both
No

Purposely did Chanting / Mantras *

Yes
Ancestors
Both
No

Centering Prayer, Contemplative Prayer, Soaking Prayer, Inner healing calling Jesus into your memories *

Centering Prayer
Contemplative Prayer
Soaking Prayer
Inner Healing calling Jesus into your memories
Rosary Prayer
N/A

Practiced Yoga including Kundalini yoga (for experience, for exercise, etc. and Chakra cleansing *

Yes
Ancestors
Both
No

Reiki for self or others *

Yes
Ancestors
Both
No

Practiced Martial arts (karate, judo, kung fu, Aikido, Tae Kwan Do, ninja, Tai Chi, etc.) *

Yes
Ancestors
Both
No

Practiced Pilates *

Yes
Ancestors
Both
No

Participated with iChing Reading *

Yes
Ancestors
Both
No

Did Subliminal Tapes *

Yes
Ancestors
Both
No

Fung Shei *

Yes
Ancestors
Both
N/A

Mind expansion to higher consciousness - rugs, music, mind techniques) *

Yes
Ancestors
Both
No

Feel like someone doing remote viewing or Done Remote Viewing on Others *

Yes
Ancestors
Both
No
I Have Done Remote Viewing On Others

PLEASE DO NOT SKIP ANY QUESTIONS OR FORM WILL NOT GO THROUGH. SUPERSTITION SECTION: Did you or ancestors had superstition such as blood packs, line & cracks, broken mirrors, black cats, turning apple tem, waling under a ladder, spilled salt, potions, candle burning, rabbits foot, horse shoe for luck, wishing on a star, reading fortune cookies, wishbone wishes, reading intestines, wedding cake under pillow, blowing birthday candles and making a wish, trowing bones (dolos), throwing salt over shoulder, etc. *

SPIRITUAL OBJECTS SECTION: Kashina dolls - if none put N/A in box *

Yes
Ancestors
Both
No

Own Pagan artifacts *

Yes
Ancestors
Both
No

Own Charms/Medallions *

Yes
Ancestors
Both
No

Own Tiki Figures *

Yes
Ancestors
Both
No

Own Voodoo dolls *

Yes
Ancestors
Both
No

Own Mormon Undergarments *

Yes
Ancestors
Both
No

Own Dream Catchers *

Yes
Ancestors
Both
No

Own Native African Arts *

Yes
Ancestors
Both
No

Own Tallisman *

Yes
Ancestors
Both
No

Own Native American Crafts *

Yes
Ancestors
Both
No

Own Spirit Masks *

Yes
Ancestors
Both
No

Own Alaskan Native Arts *

yes
Ancestors
Both
No

Own Owls, Frogs, *

Yes
Ancestors
Both
No

Own Masonic Bible, ring, apron, etc. *

Yes
Ancestors
Both
No

Do you have angels for protection and pray to them for protection? *

Yes
Ancestors
Both
No

Under Spiritual Objects Do you have any comments or anything you want to add? *

FRATERNITY & SECRET SOCIETIES SECTION: Have any family member been involved in any organization or you have one time or another joined fraternity and made a pledge? *

Yes
Ancestors
Both
No

Involved in Freemasonry, DeMolay, Eastern Star, Rainbow Girls, Job's Daughters, Shriners *

Yes
Ancestors
Both
No

Been involved or believe in Ku Klux Klan *

Yes
Ancestors
Both
No

Follower of Daughters of the Nile *

Yes
Ancestors
Both
No

Gone to Esoteric Temples *

Yes
Ancestors
Both
No

Follower of the Eucleian Society *

Yes
Ancestors
Both
No

part of Ogboni Fraternity, Poro Cult, Sande Cult, Neegee Society *

Yes
Ancestors
Both
No

Part of Ordo Templi Orientis *

Yes
Ancestors
Both
No

Member of Knights of Columbus *

Yes
Ancestors
Both
No

Membership to Nights of Pythias *

Yes
Ancestors
Both
No

Membership to Fraternity - Nights of the Golden Eagle *

Yes
Ancestors
Both
No

Membership to Fraternal Order of Owls *

Yes
Ancestors
Both
No

Involved with Brotherhood of Ram *

Yes
Ancestors
Both
No

Involved in Son of Satan, The Order of Nine Angels *

Yes
Ancestors
Both
No

Member of The Order of Temple of Set *

Yes
Ancestors
Both
No

Bilderberg Group, Trilateral, Illuminati, The Skulls and Bones, The Elders of Zion, The Knights of Templar, The Rosicrucians, Committee 300, Bohemian Grove, The German Thule Society *

Yes
Ancestors
Both
No

Believe and Part of Skinheads/Neo-Nazi Group *

Yes
Ancestors
Both
No

Part of the Fraternity of The United Ancient Order of Druids *

Yes
Ancestors
Both
No

Part of The United Order of the Golden Cross *

Yes
Ancestors
Both
No

The Fabian Society *

Yes
Ancestors
Both
No

Part of the Inner Peace Movement *

Yes
Ancestors
Both
No

Afrikaner Broederbond Secret Society *

Yes
Ancestors
Both
No

Theosophical Society *

Yes
Ancestors
Both
No

IN THE CHURCH SECTION: Necromancy - praying to the dead (Duet. 18:9): *

Yes
Ancestors
Both
No

Participated with Christian Yoga *

Yes
Ancestors
Both
No

Prayed Manipulative Prayers *

Yes
Ancestors
Both
No

Participated in Trance Dancing *

Yes
Ancestors
Both
No

Praying to Angels, to Mary, to Saints or family members who have died (Deut 18:11) *

Yes
Ancestors
Both
No

Worship of Santaria *

Yes
Ancestors
Both
No

Calling Priest Father (Matthew 23:9) *

Yes
Ancestors
Both
No

NEW AGE SECTION - YOU BELIEVE THE FOLLOWING ITEMS BRING DIVINE HEALING - American Indian Powwows, Medicine Wheel, Dream Catcher, Totem Poles *

Yes
Ancestors
Both
No

Worship Mother Earth / Gaia *

Yes
Ancestors
Both
No

Gone to a Shiatsu Practicioner *

Yes
Ancestors
Both
No

Studied and believed in Self-Realization *

Yes
Ancestors
Both
No

Studied and Practiced Self-Actualization *

Yes
Ancestors
Both
No

Gone through fire tunnels *

Yes
Ancestors
Both
No

Believe in Feminism and/or female goddesses in Wicca *

Yes
Ancestors
Both
No

Believed in Humanism *

Yes
Ancestors
Both
No

Power Objects like rocks *

Yes
Ancestors
Both
No

Human Potential Movement *

Yes
Ancestors
Both
No

Went to Life Spring Event - Christian Version *

Yes
Ancestors
Both
No

Participated in Fellowship with the Sword *

Yes
Ancestors
Both
No

PLEASE DO NOT SKIP ANY QUESTIONS OR FORM WILL NOT GO THROUGH - OTHER SECTION: Movies (are you pulled or attracted to the type of movies: Aliens, Ghosts, Paranormal, Murder, violent movies, psychic movies, witchcraft movies, werewolves, New Age Movies? *

Yes
No

Yes - signs and symbols of the New Age: Unicorns, Rainbows, Hippi Memorabilia, Peace Sign, see link https://www.crossroad.to?Books/symbols1.html *

Yes
No

Occult Music: Demonic Rock - Kiss, Led Zeppelin, Rolling Stones, Stephen Halpern, Slam Music, Gothic Rock Music, Punk Rock Music *

Yes
No

New Age Music: see website: https://simplicityinchriwst.wordpress.com/list-of-pretendersteachers/ *

Yes
No

Studied and did color therapy *

Yes
Ancestors
Both
No

PLEASE DO NOT SKIP QUESTIONS OR FORM WILL NOT GO THROUGH - MEDICINAL HEALING SECTION - Magnets for Healing *

Yes
Ancestors
Both
No

Used Crystals for healing *

Yes
Ancestors
Both
No

Had Iridology (eye Diagnosis) done *

Yes
Ancestors
Both
No

Went to Practitioner for Pendulum Diagnosis *

Yes
Ancestors
Both
No

Gone to a Psychic Healing Practitioner *

Yes
Ancestors
Both
No

Bought Homeopathic products for healing *

Yes
Ancestors
Both
No

Attitudinal Healing *

Yes
Ancestors
Both
No

Done Applied Kinesiology on Products *

Yes
Ancestors
Both
No

Done Naturopathy For Divine Healing *

Yes
Ancestors
Both
No

Gone to a Therapeutic Touch Practitioner for Healing *

Yes
Ancestors
Both
No

Believed in Tai Chi and Qi Gong for Healing *

Yes
Ancestors
Both
No

Guigong *

Yes
Ancestors
Both
No

Have had Reflexology done *

Yes
Ancestors
Both
No

Acupuncture for Healing *

Yes
Ancestors
Both
No

Guided Imagery (including inner healing - calling Jesus into the source of your pain) *

Yes
Ancestory
Both
No

Gone to Past-lives Therapy Practitioner *

Yes
Ancestors
Both
No

Participated in Polarity Balancing with Practitioner for Healing *

Yes
Ancestors
Both
No

Rebirthing *

Yes
Ancestors
Both
No

Done Shiatsu for Divine Healing *

Yes
Ancestors
Both
No

Bach Flower Remedy for Healing *

Yes
Ancestors
Both
No

Hypnotherapy for Healing *

Yes
Ancestors
Both
No

Alexander Techniques for Healing *

Yes
Ancestors
Both
No

Ayurveda for Healing *

Yes
Ancestors
Both
No

Chelation Therapy for Healing *

Yes
Ancestors
Both
No

Energy Medicine for Healing *

Yes
Ancestors
Both
No

Light Therapy for Healing *

Yes
Ancestors
Both
No

Macrobiotic for Healing *

Yes
Ancestors
Both
No

Aromatherapy for Healing *

Yes
Ancestors
Both
No

Moxibustion for Healing *

Yes
Ancestory
Both
No

Nutritional Healing *

Yess
Ancestory
Both
No

Pranic Healing *

Yes
Ancestory
Both
No

Quantum Healing or Therapy *

Yes
Ancestors
Both
No

Primal Scream Therapy for Healing *

Yes
Ancestors
Both
No

Rolfing *

Yes
Ancestors
Both
No

Water Cure for Healing *

Yes
Ancestors
Both
No

Electrohomeopathy for Healing *

Yes
Ancestors
Both
No

Use Herbs for Healing *

Yes
Ancestors
Both
No

use Holistic Medicine for Healing *

Yes
Ancestors
Both
No

Use Chinese Medicine for Healing *

Yes
Ancestors
Both
No

Metaphysicsl for Healing *

Yes
Ancestors
Both
No

Radesthesia for healing *

Yes
Ancestors
Both
No

Macro Diet for Healing *

Yes
Ancestors
Both
No

Energy Healing *

Yes
Ancestors
Both
No

Waving a Radionics Wand for Healing *

Yes
Ancestors
Both
No

Bioenergetics for Healing *

Yes
Ancestors
Both
No

Trance Diagnosis For Healing *

Yes
Ancestors
Both
No

Gone to a Deepak Chopra Seminar, Retreat, etc. *

Yes
Ancestors
Both
No

Orthomolecular medicine or Mega Vitamins for Healing *

Yes
Ancestors
Both
No

Psychology Section: Dream Works *

Yes
Ancestors
Both
No

Siddha Medicine for healing *

Yes
Ancestors
Both
No

Studied Carl Jung, Sigmund Freud, Fritz Perls, Abraham Maslow *

Yes
Ancestors
Both
No

PLEASE DO NOT SKIP QUESTIONS OR FORM WILL NOT GO THROUGH - ANTICHRIST SECTION: Obsessions: Have you ever had a desire to renounce God or Christ? *

Yes
Ancestors
Both
No

Blasphemous Thoughts *

Yes
No

Denying the existence of Satan or Demons or hell *

Yes
No

Denying the Bible is God's Word *

Yes
No

Denying Jesus is God and was Resurrected from the Dead? *

Yes
No

Denying the atonement of Christ *

Yes
No

Hostility to rejection of God *

Yes
No

Hostility to rejection of the Bible *

Yes
No

Have you ever had a desire to curse God or Christ *

Yes
No

Other Comments *

ANCESTRAL/CULTURAL BACKGROUND SECTION - Shamanism Cultural dances & rituals *

Yes
Ancestors
Both
No

Contact with ancestral spirits? *

Yes
Ancestors
Both
No

Do you have Psychic tendencies? *

Yes
Ancestors
Both
No

Contact with ghosts/apparitions? *

Yes
Ancestors
Both
No

Marked changes in your moods or mood swings? *

Yes
No

Near-death experiences? *

Yes
No

Hearing the voice of someone dead? *

Yes
No

Possessed by entity *

Yes
No

Eyes turning red when angry *

Yes
No

Feeling like there is clawing inside? *

Yes
No

Speaking an unknown language (other than Holy prayer language)? *

Yes
No

Hearing hissing sounds? *

Yes
No

Seeing unusual lights or orbs? *

Yes
No

Burning when anointed with Oil? *

Yes
No

Feeling very cold or having he room become very cold suddenly? *

Yes
No

Unexplained electronic or mechanical equipment malfunctioning around you frequently and unexplainable? *

Yes
No

Go into altered state of consciousness without alcohol or other drugs? *

Yes
No

Feeling like external forces have control or power over you? *

Yes
No

Feeling like you're seeing, or are actually in a heavy mist or fog? *

Yes
No

Feelings of pressure or suffocation on your chest *

Yes
No

Bites, scratches or other physical attacks on your body while sleeping *

Yes
No

Coughing, spitting up phlegm, or vomiting in response to prayer *

Yes
No

Is your spouse, parent/guardian, or other close family member aware that you are seeking deliverance? *

Yes
No

Do you currently have any unhealthy or codependent friendships or relationships? *

Yes
No

Do you feel you may have unbroken soul ties from previous relationships? *

Yes
No

UNWHOLESOME ENTERTAINMENT SECTION: Have you felt a strong attraction to offensive rock, rap or death metal music? *

Yes
No

Have you ever played violent video or computer games? *

Yes
No

Have you read horror and occult books? *

Yes
No

Have you ever had a fascination with violence? *

Yes
No

Have you ever been involved in role playing games such as: Majik, Pokemon, Dungeons & Dragons, etc. *

Yes
No

Have you attended Raves? *

Yes
No

Did you ever place a curse on anyone or anything? *

Yes
No

Did you ever play the "Bloody Mary" game as a child? *

Yes
No

Have you ever astral projected? *

Yes
No

Have you ever taken any secret oaths? *

Yes
No

PLEASE DO NOT SKIP QUESTIONS OR FORM WILL NOT GO THROUGH - DEMONIC MANIFESTATIONS SECTION: Have you ever had an sudden onset of confusion, abduction by something you believed to be an alien creature? *

Yes
No

Have you ever had foaming at the mouth? *

Yes
No

Smelling strong, foul odors that shouldn't be there like sulfur smells? *

Yes
No

Unexplainable changes in your voice? *

Yes
No

Convulsions or seizures? *

Yes
No

Unexplainable falls and accidents? *

Yes
No

Poltergeist activity? *

Yes
No

Seeing ghosts or apparitions? *

Yes
No

Sudden weakness or dizziness that is not medical and unexplainable? *

Yes
No

Inability to move or speak at night like something holding you down? *

Yes
No

Seeing monsters? *

Yes
No

Episodes of unusual strength without explanation? *

Yes
No

Feeling a dark presence near you or you feel like something is watching you on the spiritual side? *

Yes
No

Seeing fairies? *

Yes
No

Seeing dark shapes or shadow figures around you? *

Yes
No

Urges to destroy a Bible *

Yes
No

Fear of anointing oil *

Yes
No

Hearing audible voices outside of yourself when no one else is speaking? *

Yes
No

Unable to pray to God or Jesus *

Yes
No

Seeing Visions of Someone *

Yes
No

Seeing UFO Sightings *

Yes
No

Thoughts Taken From You or Thoughts Coming at You that are unusual *

Yes
No

A Hatred for Christians *

Yes
No

Have you ever made a pact or covenant with the Devil? *

Yes
No

If yes to making pact with Devil - why, when, what did you make this pact? Have you suffered any consequence? *

Are you willing to renounce making a pact with the Devil? *

Yes
No

Did you ever perform a ritual murder? *

Yes
No

Have any curses been placed on you or your family that you are aware of? *

Yes
No

If yes that curses have been placed on you, please explain *

Feelings like you were possessed by the spirit of a dead person? *

Yes
No

Feelings of being choked or unable to breathe when attempting prayer? *

Yes
No

Having feelings controlled by someone or something outside of you? *

Yes
No

Fear of, mocking, or revulsion toward Christian symbols, objects, music, etc.? *

Yes
No

Do you hear voices or conversations in your head? *

Yes
No

Do you ever feel like something is trying to get you to get involved in illegal, immoral, or destructive activities? *

Yes
No

Have you ever taken hallucinogenic drugs (cocaine, heroin, sniffing glue, hash, peyote to get a trip? *

Yes
No

Have you had idols or objects you worship such as angels, mother marry, saints, goddesses, deities, Santeria, other *

Yes
No
Parents Do
N/A

Have you ever done mind control to change an individual's behavior or thoughts? *

Yes
No

Are you willing to renounce and get rid of materials out of your house? *

Yes
No
Maybe
N/A

If not willing to renounce, please explain or put N/A in box: *

Thank you for taking the time to fill out this long form. PLEASE CHECK TO MAKE SURE YOU DID NOT SKIP ANY QUESTIONS

Do You Have New Age or Occult Materials In Your Home and Willing to Get Rid of Them? *

Does not apply to me
Yes, willing to remove all
No, I am not willing to remove everything
Thinking about it.

Do you suffer from anxiety? *

Yes dealing with anxiety and depression
Yes dealing with Panic attacks
Yes dealing with Phobias
Yes having a hard time coping at work
No, none of the above
Sometimes, but managing it

Any Other Modalities You Were Involved In Not Listed, Please do not skip

Add your full name here *

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