Pre-Deliverance Form

  • PRE-DELIVERANCE FORM

  • WE ARE CURRENTLY NOT ACCEPTING NEW DELIVERANCE FORMS.

    WE ARE NOW BOOKED THROUGH JUNE, AND WE CLOSE FOR THE SUMMER.

    WE WILL START ACCEPTING NEW DELIVERANCE FORMS (APPLICANTS) IN SEPTEMBER. PLEASE COME BACK AT THAT TIME. BLESSINGS!

  • For The Brokenhearted Ministry specializes in deep, deep deliverance. There will be no stone left unturned and everything will be brought to the surface. Your deliverance journey could require 1-2 sessions. We recommend that if you have undergone mass (group) deliverance at an altar, it is important to seek deeper deliverance to uproot what was left. The Bible says, "The truth will set you free" (John 8:31). So coupled with your deliverance, we will also equip you with biblical understanding to receive and maintain your freedom. To begin the process and prepare the deliverance team for your session, please provide your history in the questionnaire below. All information is strictly confidential and will only be discussed by the ministry team. The way you approach deliverance can determine your victory. It is vital for the success of your deliverance to be honest, transparent, and forthcoming while answering the form. The information you provide will expose every legal right or open door the enemy has against you. Deliverance is not a religious experience, it's a legal exchange. Once the legal rights are broken, your enemy has to release you. Please do not leave out any requested information.

    We suggest using a computer/laptop (rather than your phone) to complete this form. Do not hit the back-page button while filling out the form or you can lose all of your information. We suggest completing the form in one sitting so you do not lose your information. Average time to complete form is one-hour. If you lose your information, there is nothing we can do. You will have to fill out the form again.

  • DELIVERANCE HOURS

  • -Wednesday's at 4:30pm (CST)

     

    *We ask for your patience, we are booked out 2-3 months in advance*


    *The ministry is CLOSED every June, July, and August. We reopen sessions in September*

     

     

     

  • PERSONAL INFORMATION

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  • Do you have any previous marriages (other than your current)?
  • Are you pregnant? (Yes, we will perform deliverance on women who are pregnant up through 7 months).
  • Are you a Christian (Born-Again)?*
  • Have you been water baptized by your own choice (not as a baby)?
  • Do you speak in tongues through the Holy Spirit?
  • Have you been through deliverance prior to this session?
  • Was your prior deliverance successful in driving out demons?

  • BEFORE YOU START

  • This ministry will NOT perform a deliverance on a NON-Christian:*

  • REQUIREMENTS

  • 1.) During deliverance you will need to forgive and release ALL people who have hurt you. Forgiveness is a choice not a feeling. 2.) You must be ready to repent and turn from ALL sin and renounce it in deliverance. If you plan to continue in sinful and bad behaviors (pornography, pre-marital sex, homosexuality, masturbation, adultery, vaping, nicotine, weed, theft, Occult practices, etc.) then deliverance is not for you at this time. 3.) Lastly, you must be willing to be completely transparent and not keep anything from the deliverance team. Please carefully select the following choices that apply to you:*

  • * If you checked any of the last three selections in the question above. Do not proceed in filling out the rest of this form. Deliverance is not for you at this time. Questions? Go to the "Contact Us" page on this website and submit your questions.

  • ANCESTRAL HISTORY

  • Psalm 58:3- "Even from birth the wicked go astray; from the womb they are wayward."

    Demonic spirits can enter from the womb. Generational permission as forewarned in Exodus 20:5 is a possibility in anyone's life. There are many ancestors in your history that could have passed a spirit(s) onto you (and your children) through your bloodline.  Likely, you only know about your parents and each of their two parents. Your ancestral background is important in order to break generational curses passed down from generation to generation. To understand more about curses, read Deuteronomy chapters 27 and 28. We also highly recommend the book, "Blessing Or Curse: You Can Choose" by Derek Prince. 

  • Select your PRIMARY ethnic background(s) or ancestral heritage below. This helps us identify possible ancestral belief systems or religious practices.

  • Europe
  • Latin America
  • Africa
  • Middle East
  • Asia
  • Indigenous/Tribal
  • Other
  • Are you aware of your ANCESTORS involvement in any of the following areas (not YOUR involvement):*

  • PERSONAL HISTORY

  • "For the Lord has rejected his people, because they have filled their land with practices from the East (Eastern Religions) and with sorcerers (witchcraft), as the Philistines do. They have embraced pagan customs."

    Isaiah 2:6

  • "You must not worship the gods of other nations or serve them in any way or imitate their evil practices."

    Exodus 23:24
  • Select any involvement YOU ever had with the following Pagan or Eastern Practices, False Religions, or Witchcraft. Even if only participated once and however innocent it seemed at the time. ONLY check if you know for sure you did it. DO NOT CHECK THE BOX IF YOU DID NOT PARTICIPATE IN THE ACTIVITY!*

  • *** If you are interested in understanding some of the caution behind Halloween, Yoga, Chiropractic, Martial Arts, Tattoos, Freemasonry, Essential Oils, Pokemon, Enneagram, Himalayan Salt Lamps, Dreamcatchers, Acupuncture, Cupping, Burning Sage, Horoscopes, and Astrology. Go to "Frequently Asked Questions" on this website and under the section, "Common Practices That Seem Innocent," you will find an explanation. ***

  • Are you willing to stop engaging and renounce any involvement you had in the list above in order to move forward in deliverance?*
  • Have you ever participated in territorial warfare, or "Regional Land Work?" Where you go to a property or land that has a high activity of demonic presence and perform spiritual warfare against the principality or demonic activity in order to regain that territory back to the Lord?
  • Have you knowingly eaten Halal meat? (Lots of American restaurants and chains use Halal meat [Example: Daves Hot Chicken]. Halal meat involves a religious invocation to Allah during slaughter which is a religious dedication under Islamic law - see 1 Cor 10:20-21).
  • Did you love to watch horror movies?
  • Do you currently believe in reincarnation? (You have past lives or when you die you come back to earth as someone else).
  • Do you talk or communicate to the dead? (Speak to past loved ones or conjure their spirits up).

  • ACCURSED ITEMS

  • Do you have any accursed items in your home or possession attributed to the occult, idolatry, ungodliness, other religions, Eastern practices, witchcraft or cults? Select those that apply.*

  • Deuteronomy 7:25-26 The Lord says, "You must burn up the images of other false gods; do not covet the silver and gold that is on them or take it for yourselves, or you will be ensnared by it; for it is detestable to the LORD your God. And you must not bring any detestable thing into your house, or you, like it, will be set apart for destruction. You are to utterly detest and abhor it because it is set apart for destruction."

    Acts 19:19- "Many of those who had practiced magic (and witchcraft) brought their books (and occult items) together and burned them in the sight of all. And they counted up the value of them, and it totaled fifty thousand pieces of silver (equates to $2 million today)."

  • Are you willing to get rid of these items BEFORE deliverance (they are open doors/portals)?
  • Do you have any of these items in a storage unit? Before deliverance, they will need to be thrown out.

  • BELIEFS AND BEHAVIORS

  • Please select which applies to you regarding DISCRIMINATION and JUDGEMENT. You can select more than one.*
  • Please select which applies to you regarding IDENTITY and ABUSE. You can select more than one.*
  • Did you have imaginary friends as a child?
  • Select which sexual acts you have EVER participated in, consensual or not. Do not leave anything out.*
  • Please select which applies to you regarding SEXUAL IMMORALITY. You can select more than one.*
  • I have committed adultery on my current spouse?*
  • I have fully confessed the adultery/pornography/sexual deception to my spouse. There is nothing my spouse does not know regarding sexual deception in our marriage.*
  • It is important to understand that in order for your deliverance to be successful, the enemy can no longer have legal permission through concealing your infidelity. It is our experience that if a spouse has unconfessed adultery in the marriage, the evil spirit will manifest during the session but will NOT come out. Infidelity is a serious matter in God's eyes and it needs to be confessed to your spouse since the foundation of the marriage is unstable. At the root, there is secret sin against the marriage coupled with lies and deceit. Proverbs 28:13 says, "Whoever conceals their sins does not prosper, but the one who confesses and renounces finds mercy." Do you understand that we will NOT move forward with driving demons out, unless ALL adultery, pornography, sexual deceit has been confessed to your spouse?*
  • WIVES: Please select any that applies when intimate with your husband*
  • Please select which applies to you regarding CONCEPTION and SEXUAL IDENTITY. You can select more than one.*
  • Please select which applies to you regarding REBELLION and SINFUL NATURE. You can select more than one.*
  • Please select which applies to you regarding FORGIVENESS and HEART POSTURE. You can select more than one.*
  • Please select which applies to you regarding DEPRESSION and ANXIETY. You can select more than one.*
  • Please select which applies to you regarding your SLEEPING PATTERNS. You can select more than one.*
  • Please select which applies to you regarding CONFUSION and EATING HABITS. You can select more than one.*
  • Please select which applies to you regarding FEAR and PARANOIA. You can select more than one.*
  • Please select which applies to you regarding DOUBT, REJECTION, and ANGER. You can select more than one.*
  • Select if any apply regarding MONEY. You can choose more than one.*

  • TRAUMA AND INNER HEALING

  • Do you currently struggle with trauma from a past traumatic experience or time in your life?
  • Have you received inner healing or counsel dealing with past trauma?

  • MEDICAL HISTORY

  • BEFORE YOU GO

  • PREPARATION FOR DELIVERANCE

    Things to consider

  • In Mark 9:29, the disciples were unable to cast out demons from a young boy.  When they asked Jesus why, He replied, “This kind (of demon) can only come out by fasting and praying.” We highly suggest joining the deliverance team in praying and fasting before your session.  A possible suggestion is to fast the day before your deliverance. We do not suggest fasting the day of your deliverance unless the Lord prompts you.  

    It is not uncommon to need 2 sessions in order to be completely free. Evil spirits travel in packs and we have never seen or led a deliverance where only one spirit was present. This is why some people require several sessions. We also cannot guarantee that you will be set free.  Your participation, transparency, honesty, and desire for freedom is the key to helping us deliver you from demonic oppression.  

    Deliverance will take several hours, we suggest you wear comfortable clothes.  Ladies, please wear clothing that completely covers your chest, stomach, and upper legs. Please no skirts or dresses. We are unaware of how you will manifest during deliverance and if you wear a low-cut shirt, you can be exposed during deliverance. Our top priority is that you are treated with the utmost respect and dignity.

    It is important to understand that when you experience genuine deliverance and evil spirits leave your body; You will feel lighter, your mind will stop racing, your ability to connect with God won't be hindered, your specific manifestations will stop, you will not feel pain, you could experience healing, and you will feel like a new person. As wonderful as all that sounds, it is important to put into perspective that deliverance does not mean life will be perfect. Jesus did not promise that and neither do we. Deliverance is like a reset button. You get to face life without hindrances but sin and temptation are still around the corner. If you open the door, you already know who will come in. Your work does not stop when the evil spirits leave. In fact, it's only beginning. It's important to seek wisdom and discernment on how to maintain your deliverance by keeping the doors closed and every entry point shut. 

     

  • It is important that you read the entire 'Frequently Asked Questions' (FAQ) page on this website BEFORE your session. It is extremely important to be fully aware of what is required for a successful deliverance. By reading the FAQ page, it will also prepare you for what to expect. Knowledge is key and the truth will set you free!*
  • Are you willing to participate in a 24-hour liquid fast the day before your deliverance session(s)?*

  • SESSION FEES

    • Zoom Deliverance, per session: $310.00 (includes $10 credit card fee)
    • Zoom Deliverance, plus One Hour Counseling w/ Holly: $410 (includes $10 CC fee)
    • Zoom One Hour Counseling w/ Holly: $135 (includes $10 credit card fee)
    • There is a $10 credit card fee already included in the amount above for online transactions. 

     

    It is important to understand that you are not paying to receive freedom. Deliverance is free. This fee pays the ministry for the considerable amount of time, services, and resources dedicated to your journey for freedom. This is a full-time deliverance/counseling ministry.

    The session fee is non-refundable. You have the flexibility to reschedule for free as long as you cancel your original appointment 24 hours in advance. If you request multiple reschedules in a row, the deliverance team has the option to not reschedule with you and the fee remains non-refundable. 

     

  • CANCELLATIONS

  • The deliverance fees are non-refundable but you have the flexibility to reschedule your session at a different time as long as you notify the ministry of your cancellation within 24 hours. In the case that you have to cancel your deliverance session, we ask that you kindly notify us at least 48 hours before your appointment. Our desire is to give your time slot to another person since our current scheduling is weeks out. The deliverance team begins to pray and fast for each deliverance 24 hours prior to the appointment and we need enough time to prepare. If you request multiple reschedules in a row, the deliverance team has the option to not reschedule with you and the fee remains non-refundable.

  • LIABILITY RELEASE FORM

    Must be signed before deliverance

  • For The Brokenhearted Ministry is a biblically-based prayer ministry. It is considered a form of pastoral counseling, not professional counseling. We work with you as you choose to work with us. If you are dealing with serious conditions like physical and mental illness or addiction, please do not disregard seeking professional help in conjunction with the help you seek through divine healing.

    For The Brokenhearted Ministry commits to keeping your personal information concealed. However, this ministry is required by law to report any physical and sexual abuse currently taking place with a minor. 

    We are not licensed medical professionals: This ministry is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this form or encountered through this ministry.

    I hereby acknowledge and affirm that all the answers given by myself in response to the questions in this form are voluntarily submitted and the information is true to the best of my knowledge.  I hereby release, indemnify and forever hold harmless For The Brokenhearted Ministry and its agents, staff, employees, and volunteers of any damages, real or perceptual, arising from personal ministry in connection with the information submitted herein.

    1.) I release, waive, discharge and covenant not to sue For The Brokenhearted Ministry, their officers, servants, agents, volunteers, staff or employees from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me, whether caused by the negligence of the Ministry or otherwise, while participating in such activity, or while online or in, on or upon the premises where the activity is being conducted.

    2.) I am fully aware of risks and hazards connected with the activity, and I elect to voluntarily participate in the activity, and to engage in such activity knowing that the activity may be hazardous to me and my property. I voluntarily assume full responsibility for any risks of loss, property damage or personal injury, including death, that may be sustained by me, or any loss or damage to property owned by me, as a result of being engaged in such an activity, whether caused by the negligence of the Ministry or otherwise.

    3.) I further agree to indemnify and hold harmless the Ministry from any loss, liability, damage or costs, including court cost and attorney fees, that they may incur due to my participation in the activity, whether caused by negligence of the Ministry or otherwise.

    4.) It is my express intent that this Release and Hold Harmless Agreement shall bind the members of my family and spouse, if I am alive, and my heirs assigns and personal representative, if I am deceased, and shall be deemed as a release, waiver, discharge, and covenant not to sue the above named Ministry. I further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of Texas.

    In signing this release, I acknowledge and represent that I have read the above Waiver and Liability and Hold Harmless Agreement, understand it and sign it voluntarily as my own free act and deed; no oral presentations, statements, or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent; and I execute this Release for full, adequate and complete consideration fully intending to be bound by same.

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  • Questions: Contact the ministry at

    info@FTBH.org

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