A2V C3 - (TOG) - Healing and Deliverance Ministry - Don't skip question or it won't go through

E-mail Address: *

C1 - First Name *

Last Name

Sex:

Male
Female

Contact Phone *

What part of the World are you located?: State, Country, etc.

Choose your issues *

Need Healing in Body
Demonic Attack or Witchcraft Attacks
Kundalini Issues - I feel something going up and down my spine and other manifestations
Mental Issues (depression, bipolar, other)
Feel Stuck and blocked in my life, in finances
Rejection (I don't fit in)
I feel abandoned by God
Generational Curses
My generations involved in Freemasonry
Fear and Anxiety due to trauma
Feel hurt from others and feel tormented
I have bitterness towards others
I self-abuse
Oppression and Heaviness
I Was involved in the occult, new age, did yoga, and feel demons attacking me
I was involved sexually and tormented or have guilt - cannot forgive myself
I have uncontrollable sexual appitite
I've been molested and/or raped and feel guilt
I have addictions to drugs, alcohol, gambling, other
I feel tormented in my thoughts
I have anxiety
I cannot get ahead financially
I'm hurt and cannot forgive
I have a hard time forgiving myself for the past
I fee like my sin is too big for God to forgive me
Other
None here - my issues are different

Need Personal Ministry For: *

Please list any medical doctor or mental health diagnosis. If none, type in none otherwise form will not go through. *

List any prescription drugs nutritional remedies and what are they for. If no, type none otherwise the form will not go through

Growing Up *

Growing up I could meet my mom's expectations
Growing up I could not meet my mom's expectations
Growing up I could meet my dad's expectations
Growing up I could not meet my dad's expectations
I had an overly strict parent(s)
I had an overly critical parent(s)
I have a hard time forgiving myself for my past mistakes
I grew up walking on eggs around my parent(s)
I grew up in an alcoholic home
I grew up in a drug environment
My mom did not nurture me
My dad was not involved in my life
My parents did not discipline me
My parents did not establish a routine in my life
I felt controlled and put down 50% of the time
I was not planned
I felt like I was a mistake being born
I mom was storng and manipulative with guilt
My dad was strong and manipulative with guilt
I never felt good enough
I was sexually abused in the home
I was sexually abused outside the home
I was verbally and/or physically abused by my dad
I was verbally and/or physically abused by my mom
I feel insecure 50% of the time
I feel worthless 50% of the time
I battle with depression 50% of the time
I have a broken heart
I am performance oriented to feel good about myself to get praise
My parents were not married when I was conceived
My parent(s) - adultery
My parents divorced when I was young
Got pregnant when I was young and had an abortion
Forced to have an abortion by my parents (boyfriend)
I'm attracted to the same sex
I grew up with same-sex parents
I had a sex-change operation
None apply to me

Later Years (marriage, children, divorce) *

My husband/wife manipulated me
My husband/wife physically abused me
My husband/wife emotionally abused me
My husband/wife verbally abused me
I lost a child after birth
I lost a child miscarriage
My husband/wife refuses to work
Moved many times in our marriage because of finances
We loved homeless or lived with family to make ends meet
My husband/wife drinks
My husband/wife does street drugs and legal drugs (addiction)
I ended up divorcing
I'm stuck in the relationship
My husband rapped me
I've lost jobs because of the abuse at home
I have a good marriage
I lived with a man who abused me
I chose to have an abortion
My spouse is a narcissist and he emotionally plays games
My spouse makes me do unnatural sex
Other
None apply to me

How I feel today about yourself or think *

I don't fit in
I feel insecure
I feel accusation by others
I feel that God has rejected me
I have self-pity
I false burden bearning
Hard for me to make decisions
I suppress my feelings
I have a broken heart from my family
I have a broken heart from my husband/wife
I suffer from self-accusation, self-condemnation, self-blaming myself when things go wrong
Need for love, Approve and Acceptance fro others
Need for identity
I feel despair 50% of the time
I take on false responsiblity
I murmure and complain a lot
Something must be wrong with me
I don't feel like I belong anywhere
I try to meet other people's expectations and feel guilt when others are made or disappoined in me
I'm bombarded with negative thoughts that I cannot control
I am performance oriented to feel good about myself or to get praise from others or at work
I have fear of rejection
I feel like everyone is against me
It matters what people think of me
I get jealous of others
I overthink trying to make a decision or replay hurts
Self-comparing myself to others
Self-critical voice
Self-curse myself when things go wrong
Self-doubt myself
Projecting things to go bad in the future
I get paranoid that people are talkin about me
I have a hard time trusting God - I don't think he is for me or loves me
I get anxious around relationships
I have a hard time saying no when I know I need too - fear of rejection
Excessive worrier
I am highly competitive and cannot lose
I pick fights with people to reject me
I reject others before they reject me
I'm self-centered
Stubborness
Love power and position
I control others so that I don't get hurt
I feel like I've been overlooked
I feel I am stupid
I feel like no one cares about me
I suffer from oppression and heaviness
I am not loved
I feel like I have no value to anyone or God
I live with guilt, shame, and regret from the past
I think about suicide at times
I've tried to take my life
I have a drinking problem
I have addiction to pornogray
I have addiction to sex
I have addiction to gambling
I feel like a victim
I've self-mutilated myself in the past or currently hurt myself when things go wrong
I feel not necessary, important or needed
I struggle with anorexia or bolemia
None apply to me

Any past regrets, or sins in the past you replay and still have shame or guilt or cannot forgive yourself? If yes, please explain or list, if not type N/A *

Are you on prescriptions or taking supplements to bring relief, or other types of treatment? Please list them. *

Did you family members have the same issue? Please list the disease and how they are related *

Did you go through any traumatic events or received bad news in your life that brought pain, numbness, shock, terror, horror? Please explain otherwise N/A *

You've been hurt by others and feel resentment or bitterness? *

I feel resentful of that person
I feel hurt and want to get even
I intentionally turn away to ignore and avoid him or her
When someone mentiones his or her name it leaves a bitter taste in my mouth
Just thinking about him or her makes me sick to my stokmach
When I think of the person I feel offended
I resent his or her success hearing any good report about him or her
I secretly desire misfortune or failure or worse to come to his or her life
I don't believe I have to forgive them
I know I need to forgive them
I am having a hard time forgiving him or her
I feel separated from God when I pray
I condemn people
I am judgmental and accusatory
I gossip to others about what they did to me
I keep a record of wrong
I feel misunderstood
I feel tormented and cannot stop replaying what this person did to me
I refuse to forgive him or her or them
I blame God
I don't understand why God had me go through this
None of the above apply to me
Make sure you fill out the Bitterness List: https://www.mycontactform.com/hosted/form.php?formid=454737

Past, Present, or Family Involvement in the supernatural - Part 1 - sins of the forfathers goes 4 generations *

American Indian Ceemonies
Used Herbal Medicine for Divine Healing
Sweat Lodges
Powewows
Dream Cather in Your Home
Medicine Wheel in Your Home
Angel Worship - you pray to angels
Pray to saints
Yoga of any type - even Christian
Ascended Masters: Elizabeth Clair Prophet
Astral Projection
Astrology
Horoscopes
Zodiac Signs
Aura Reading
Automatic Writing
Chanting / Mantras
Charms: Ankh, Tailsmans, INdian Horns, Horseshoes, Rabbit's Foot, Scarub
Energy Balancing: Chi, Ying and Yang, and Other
Clarvoyance: Clair Audiene, Mental Telepathy, ESP
Colorology
Conjuration: Incantation, Channeling, Mediums
Course of Miracles: Helen Schumann, Kenneth Wapnick, Gerald Jampolsky
Crystal Balls / 8 Ball
Crystals, Birth Stones, Power Rocks for Enegy, Balancing, Healing
Cultural Pagan Ceremonies
Death / Dying Movement: Elizabeth Kublar-Ross, Tibetan Book of the Dead, Into the Light, and others
Deja Vu Experiences
Divination: Gone too someone - Tarot Card Reading, Fortune Telling, Teal Leaf Reading, Handwriting Analysis, Palm Reading, I Ching, Numerology, False Prophecy
Dream Work: Jungian, Sinoi
Drug Trips, Recreational Drugs, Pot, Mushrooms, and other substances
Dungeons & Dragons, Magic
Echankar follower
Eniagrams
Contacted Familiar Spirits - talking to the dead
Necromancy, Family Spirits, Seances, Table Tipping or Tapping, Spiritism
Feminism, Goddess Worship
Fetishes, Power Objects
False Prophets: Jean Dixon, Nostradamus, False Prophets in the Church
Feng Shui
Financial bondage to the occult
Fire-Walking
Gurus, Transcendental Meditation, Hare Krisnas, Deepak Chopra, Self-Realization Fellowship, Soaking Prayers
Humanism: Human Potential Movement, Actualizations, The Forum, LIfe Spring, Christian Version, EST (Erhart Seminar Training)
Hypnotism
Self-Hypnotism, Subliminal Tapes
Incense, Moxibustion
Inner Peace Movement
KKK, Racism
Magic: Black, White, Stage Magic
Martial Arts: Tai Chi, Karate, Judo, Kung Fu, Aikido
Mediums: Edgar Cayce, Arthur Ford, JD Knight, Swedenborg, Jane Roberts, Others
Metphysics
Mind Idolatry / Mensa
New Age Thinking and Involvement
New Signs of the New Age: Unicorns, Rainbows, New Age Symbols, Rock Music, Hippie Memorabilia
Occult Books
Occultic Finctional Characters: Elves, Genies, Leprechauns, Easter Bunny, Mother Earth, Gaia, Tooth Fairy, Dromes
Occultic Music: Demonic Rock, Stephen Halpen, Sam Dancing, other
Occultic Virtual Reality
Ouija Board
Pagan Religion/Paganism in Christianity
Parapsychology
Polates
Poltergeists
Psychic reading / Psychic Portraits
Rebirthing
Reincarnation / Past Life Regression
Satanism: Satan Worship, Halloween, Pentagrams, Sacrifice animals, done spells on people
Science Fiction: Star Trek, Star Wars, UFO's, Aliens, The Force, Others
Shamanism / Carols Castendeda
Others Not Listed
No Occult I've participated in nor have my family going back 4 generations

Check if past, present, or family involvolement - Part 2 *

Silva Mind Control, Mind Dynamics
Sorcery / Pharmakeia
Spiritism / Spirit Guides
Status of Idols: Diana, Angels, Mercury, Venus, Buddha, Idolization of MOvie Stars, Musicians, Pastors, Athletes, Gurus, and more
Stonehenge, Machu Picchu, Gone to Hindu Temples or Budda Temples
Worshipped Buddha or Hindu Gods
Superstition: Fear of Black Cats, Wishing on a Star, Friday the 13th, Salt over te Shoulder, Not stepping on lines, etc.
Theosophy: Alice Bailey, The Plan, Theosophical Society, Annie Besant, HP Blavatsky, Krishnammuri
Doing Transcendental Medication, Empything the Mind - Soaking Prayer, Centering Prayer
Voodoo / Santaria / Voudon - Worshipped or had temples
Statue of Mother Mary
Waterwitching / Geomancy
Warlock, Male and Female Witches, Involved in Wicca
Grew up in a generational witchcraft home
Witchcraft: Spells, potions, evil prayers, photographs of someone to pray against, sending curses
Jezebel / Ahab Spirit: Control and Manipulation, Matriarchal Witchcraft - controlling others
Kundalini / Chakra, Third Eye tapping, Tantra, Kamasutra
Inner Healing: Going to your past pain by closing your eyes and then inviting Jesus to the pain
Fire Tunnels
Done Smudging or parent did smugging on you
Dedicated food to the gods
Mardi Gras - beads, etc.
altar where pastries, candles, fruits, and coins are offered to their orisha
Rebirthing
Belief in reincarnation
Believed you are your own god
Spiritual Energy in objects
Tried to open Chakras
Was an agnostics, agnostics in your family
No occult or modaities I've done above nor my generations going back 4 generations
Other

Check False Religious Practices (Yourself, family involvement) - Part 3 *

Eastern Philosophies
Hinduism
Gurus
Bahaism
Buddhism
Zen, Vipassana, Tibetan Buddhism, Buddhist Meditation
Cabala / Jewish Mysticism
Scientology
Secret Brotherhoods / Sisterhoods - Fraternities and Sororities, Blood Oaths
Rosicrucianism
The Way International
Unification Church: Moonies
Urantia
Freemasonry
Eastern Star
Rainbow Girls
Elk Lodge
Orange Lodge
Independent Oder of Odd Fellows
Ancient Order of the Foresters
Latter Day Saints
Scientology
Muslim
Voodoo
New Age Practices
Other
None

New Age Medicine Practes by you, family members going back 4 generations - Part 4 *

Quantum Healing
Acupuncture
Ayurveda
Homeopathy
Naturopathy
Chinese or oriental medicine
Body movement therapy
Tai Chi
Electromagnetic therapy
Reiki
Qigong
Biofeedback
Visualism and guided imagery
Chelation therapy
Craniosecral therapy
Crystal healing
Cupping
Dowsing
Magnetic therapy
Shiatsu
Theraputic touch
Energy psychology
Feng Sui
Graphology
Isolation tanks
Isopathy
Irdology
Light therapy
Five elements
Flower essence therapy
Bach flower therapy
Messages from new agers
New thought
Nature therapy
Pranic healing
psychic surgery
Reflexology
Rolfing structural integration
Recreation therapy
Radonics
Sound therapy
Trigger points
Water Cure
Other
None

If involved in the occult, witchcraft, new age, check symptoms you are dealing with today - Part 1 through 4 *

Deep confusion
Sometimes hatred of God
Distrust of God
Inability of Sleep
Night torment or terror
Hostility and agression
Impatience
Control of Others
Suspicion (Paranoia)
Frustration a lot
Feel like you are losing your mind - insanity
Depression 50% of the time
Heaviness and Oppression
Tormenting Thoughts
Certain types of pain especially in relationships to the central nervous system
Out of body experiences
Division maker and trouble makers
Obsessions
Inability to hear God's voice
Falling Asleep in Church
Seeing Orbs
Seeing Ghostly Figures
Falling asleep while reading the bible
Rebellion against God no matter how hard you try
Stubbornness
Disobedience to God's Word as a chronic activity
Losing Interest in attending church
Losing interest in reading God's Word
I feel like knives are stabbing me
I feel movement in my body like a snake going up and down my spine
Inability to develop a prayer relationship with God
I have made vows not to be like my mom or dad
I have self-cursed myself - self accusations
I feel witchcraft curses coming at me
I have poltergeists in my home - doors slame
I hear and see loud noises, knocking on doors, moving objects, pinching, hitting, biting, tripping, and levitating furniture and objects
I feel like someone is astro projecting in my house
I hear voices that are not mine in my head
I hear voices outside my head around me
I have sexual demons touching me in the night
I feel sensations of burning, pinching and other weird pain that doctors cannot figure out
I have flashbacks or dreams of things evil done to me as a child
I am boastful
I have basphemy God, and the Holy Spirit
Others
None

If you have other modalities you or your family was involved with, please list them here: If not, put N/A in the box: *

Any Word Curses You Spoke Over Yourself examle: I am stupid? *

Do you Have a Spirit of Fear *

Fear of Deliverance
Fear of Demons
I suffer from Panic Attacks and Phobias
Fear of Tomorow or the Future
I suffer from Self-Doubt Fear of Making a Mistake
Dread - projecting things to go wrong in into the future
Fear of Change
Fear of the Unknown
Speculative Fear
Fear of Loss
Fear of Losing Life
Fear of Death
Fear of the Dying Process
Fear of Disease such as Cancer
Fear of Losing Children to Death
Fear of Losing Children to the World
Fear of Loss of Relationships
Fear of Chronic Pain
Fear of Emotional Pain
Fear of Disability
Fear of Doctors/Hospitals
Fear of Needles
Fear of Blood
Fear of God in a Negative Way
Fear of God's Punishment
Fear of God's Judgment
Fear of Other People's Judgment
Fear of Losing Salvation
Fear of Fear
Superstition
Fear of Bad News
Fear-Faith (counterfeit faith based on works)
Fear of Betrayal
Fear of Man
Fear of Authority
Self-Consciousness
Felling of Inferiority
Fear of Criticism
Fear of Reproof
Fear of Harrassment
Face Reader and When someone does not look happy afraid it is my fault
Fear of Disapproval
Fear of Verbal Rejection
Fear of Reproached - Being Shamed
Fear of Humiliation
Fear of Bad Choices
Fear of saying the wrong thing where I will look llike a fool
Fear of people finding out my past
Fear of Rejection
Fear of Abandonment
Fear of being aone and loneliness
Fear of not haiving enough of necessities (food, drin, clothing, housing)
Fear of poverty
fear of failure
Fear of losing my mind - insanity
Fear of the dark, night terrors
Fear of antigens
Fear of food, drink, clothes, housing, environment
Fear of chemicals
Gone through trauma where I felt horror, shock, terror, numbness
Fear of noices that cause me to tense up
Fear of animas (snakes, spiders, mice, dogs, etc.)
Fear of being controled and manipulated by guilt
Out of my fear I manipulate and control others
Fear of family members
Fear of spouse
Fear of natural disasters
Fear of water
Fear of war and terrorism
Fear of conflict with others
Fear of authority
Fear of pregnancy
Fear of water and drowning
Fear of heights, bridges, flying, etc.
Fer of being wrobbed
Fear of losing my job
I get anxious around relationships
Fear of COVID? That you don't go out or go to church because of fear unless you have too?
None of the above

Significant Relationsh History (sexual before marriage, during marriage), bad breakups or someone stole your boyfriend or husband (We do not request a complete list of sexual partners/ experiences). *

In me or my family (envy/jealousy) *

I compare myself to others
I feel the Lord blesses others over me
I covet what others have
I feel discontented with my life
I have a hard time trusting God
I have a critical fault finding spirit or judgmental spirit or it is in my family
I am very competitive with others - some of my family members are
I fight with pride - some of my family are very prideful
I feel superiority over others
I have self-ambition
I strife (fight with others) when they do not agree with me - some of my family members strive
I have jealousy around my spouse
I can be possessive in relationships
I can control, manipulate others - some of my family members control and manipulate
I have inordinate relations - soul ties
I have stolen in the past
I have a hard time when someone gets a promotion - I get jealous
I get suspicious or my family are very suspicious of peoopole
My mom was jealous of me, my brothers or sisters were jealous with me
My family backbitting, belittling, dispute, emnity towards each other
I am boastful or my family members were
None of the above

Behavior of Accusation *

When someone accuses, I feel I have to defend myself
I feel like the escapegoat
I feel misunderstood with my family
When someone accuses me, I feel I have to fight back
I accuse others
I get offended very easily
There is divorce in my family
I replay what others have done to me over and over again
I feel like the Lord has let me know and I accuse God for my bad fortune
I accuse my parents for my misfortune
When I get accused, I isolate
When others hurt me, I become very deceitful
I have a personality of accusation
I gossip about people
I fault find
I have chaotic thinking
I have scramling thoughts
None of the above

Do you or your family had addictions? Chose *

Drug Addiction
Social Media Addiction
Porn Addiction
Video Game Addiction
Sex Addiction
Alcoholic Addiction - have others told you that you have a drinking problem?
Gambling Addiction
Food Addiction
masturbation addiction
sugar addiction turns to alcohol
prescription painkiller addiction
heroin addiction
exercise addiction
tanning addiction
addiction in fetish
television addiction
computer addiction
work addiction
coffee addiction
legal drug xanax addiction
shopping addiction
Other Addictions
N/A

Chose That Pertains to you on core beliefs: *

I must perform to receive praise and love (God or Man)
I only get love in how I act (God or Man)
I must earn it to get love (God or Man)
I must look a certain way to get love (God or Man)
None of the Above - Core Beliefs

Core - Choose What Apply to You? *

I Am Helpless
I Am Incompetent
I Feel Vulnerable
I Am Not Loveable
I Am Inferior
I Am Not Likeable
I Am UnWorthy
I Am Bad
I Am Stupid
I Am A Burden to Others
None of the Above

Core: Did my experiences lead me to think there was something wrong with me in some way? If so, what was wrong? *

Yes
No
Sometimes
None at all

Core - Do you remember specific situations that accompany the negative thoughts or feelings you have about yourself? What memories of these situations say about you as a person? *

Core: Can I link a specific person I know to the how I feel about myself? Has that person used certain words to describe me? What does their treatment of me say about me as a person? *

Core: What are the common themes, labels, words, or names I use to describe myself? What do they mean about me? Or Negative Words Others Spoke Over You that You Still Replay or Believe? *

Did you have brother and sisters? What was your relationship?

Are you currently going through counseling or deliverance mnistry from someone else? If yes, please explain, if not type in None - otherwise the form will not go through *

When did you totally surrender to the Lord *

Are you spirit filled? *

Do you tithe? *

Yes
No
Sometimes
I don't believe in Tithing

Do you go to church almost every week or more? *

Yes
No
Not since covid and watch it on TV

Next Form: Liability Form If It does not take you to that page *

Anything Else You Want to Explain? If none, type none *

How Did You Find Me? *

* Required