Deliverance Intake Form

This part of the form is to determine possible entry points for evil spirits. Please give any information the Holy Spirit brings to your mind. You don't need to go into heavy detail in your responses. Ask the Holy Spirit to bring up any areas of concern.
Did you or your ancestors have involvement in things such as: occult, sexual perversion, alcoholism, depression, mental illness, lots of divorces, anger, rage, criminal activity, births out of wedlock or involvement in groups such as Freemason, Eastern Star, Rainbow Girls, Oddfellows, and Rebecca Lodge, etc. Ask the Holy Spirit to bring any information about this to your mind.

YesNo
If yes, please explain
Are you aware of any trauma that might have happened while you were in your mother’s womb or as a young child? (Accidents, abuse, divorce, spoken words such as “we shouldn’t be having this child”)
Do you recall any early childhood traumas, fears, injuries, nightmares? Or spiritual encounters like seeing/feeling an evil presence in your room? Please explain
Did you experience any sexual abuse or physical abuse during your childhood or adult life?
Any involvement (no matter how innocent) in ouiji boards, seances, levitation games, fortune tellers, tarot cards, astrology, horoscopes, numerology, fascination with magic, Harry Potter, etc? Please explain
Is anything coming back to you from your childhood that made you terrified at the time? Accidents, injuries, etc.
Have you had pre-martial sex?

YesNo
Do you suffer from habitual lust? Coveting eyes, adultery in your heart, pornography, sexual fantasy, promiscuity, perverse thoughts?
Past history of drug use or alcohol?

YesNo
Do you still struggle with addiction, drug, or alcohol use?
Do you experience unusual fears?
What do you think might be the areas of demonic influence in your life?
Please select all that apply to you

Homosexual tendenciesParticipated in college frat/sororitiesFeelings of guilt/shameHopelessnessEasily brought to anger/rageFatigue without medical reasonHad an abortion or participated in some way(drove someone to get one)Bitterness/unforgivenessDifficulty forgivingSuffered from self harmSudden feelings of gloomFeeling rejected/abandonedIntrusive thoughtsYou feel dark presences in your home often and recentlySuffer from nightmares/sleep paralysisHearing voices in your headHearing unexplained voices outside your head(in your house)RebelliousBlasphemous thoughtsFeeling lonelyFeeling inadequateCompulsive thoughtsFeel the need to be in controlHard time going to church or reading the Bible
Please elaborate on anything from the above list that the Holy Spirit brings attention to.
Do you have any objects in your house or possession that are related to ungodliness, cults, or occult? Things like Native American artifacts, new age items or books, crystals bought from spiritual stores, any items bought from new age/spiritual stores, horror films, heavy metal music, books on false religion, items connected to false religion or rituals, or anything else tied to Wicca or occultist practices?

YesNo
If yes, please explain what they are and if you’re willing/able to get rid of them
Do you have any medical diagnoses? Please explain each
Do you suffer from unexplained/undiagnosed pain?
Here are a few symptoms of demonic attack, remember there is no condemnation in Christ, this is just to gauge your level of demonic bondage, please check any symptom that applies to you:

A compulsive desire to blaspheme God.A revulsion against the Bible, including a desire to tear it up ordestroy it.Compulsive thoughts of suicide or murderDeep feelings of bitterness and hatred toward others without reason:Jews, other races, the church, strong Christian leaders.Any compulsive temptations, which seek to force you to thoughts or behavior which you truly do not want to do or think.Compulsive desires to tear other people down, even if it means lying to do so. Vicious cutting down of others by the tongue.Terrifying feelings of guilt even after honest confession is made to the Lord.Certain physical symptoms which may appear suddenly or leave quickly and there are no physical or physiological reason.Choking sensationsPains that seem to move around and for which there is no medical cause.Feelings of tightness about the head or eyes.Dizziness, blackouts, or fainting seizures.Deep depression and despondency.Sudden surges of violent rage, uncontrollable anger, or seething feelings of hostility.Terrifying doubt of one's salvation even though they once knew the joy of salvation.Seizures of panic or other fear that is terrifying.Dreams or nightmares that are of a horrific nature and oftenrecurring. Clairvoyant dreams that may even come true are most often demonic.Abnormal or perverted sexual desires.Questions and challenges to God's WordSleep or eating disorders without physical cause.Most compulsions and obsessionsRebellion and hatred for authority.Bizarre terrifying thoughts that seem to come from nowhere and youcannot control them.Fascination with the occult.Involvement in criminal activity.Extremely low self-image (unworthy, a failure, no good - a constant undermining of the self-identity).Constant confusion in thinking (sometimes great difficulty inremembering things).Mocking and blasphemous thoughts against preaching/teaching of the Word of God.Perceptual distortions - perceiving anger, hostility, in others when it doesn't really exist - seeing only judgment in the scriptures.Horrible nightmares causing fear (often having demonic images).Violent thoughts (suicidal, homicidal, encouraging self-abuse, etc.).Hatred and bitterness toward others for no justifiable reason.Tremendous hostility or fear when encountering someone involved in deliverance work.Feelings of being watched or sensing an evil presence.Deep depression and despondency (frequently/once a month or more, and at significant times).Irrational fears - panic attacks - phobias.Irrational guilt - self-condemnation to the extreme.Desire to do what is right (inability to carry it out).Sudden personality and attitude changes (severe contrasts - appears schizophrenic) Bi-polar disorder.A strong aversion toward scripture reading and prayer (especially oneon one).A dark countenance (steely or hollow look in eyes - contraction of the pupils - sometimes facial features contort or change - often an inability to look at others directly.Lying, exaggerating, or stealing compulsively (often wondering why)Drug abuse (especially when there is demonic hallucinations).Compulsive sexual sins (especially perversions).Irrational laughter or crying.Irrational violence - compulsion to hurt self and/or someone else.Sudden speaking of a language not previously known (often an ethnic language of ancestors)Reactions to the name and blood of Jesus Christ (verbally or throughbody language).Extreme restlessness (especially in a spiritual environment).Uncontrollable cutting and mocking tongue.Vulgar language and actions.Loss of time (from minutes to hours - ending up someplace, not knowing how you got there - regularly doing things of which there is no memory).Extreme sleepiness around spiritual things.Demonstration of extraordinary abilities (either ESP or Telekinesis).Voices/random thoughts that aren’t yours, are heard in the mind (they mock, intimidate, accuse, threatenor bargain).Voice/thoughts that refers to him/her, us/we in the third personSupernatural experiences - hauntings, movement or disappearance ofobjects, and other strange manifestations.Pain (without justifiable explanation - especially in head and/or stomach).BlackoutsPhysical ailments can often be alleviated immediately by a command of spiritual authority (i.e. epileptic seizure, asthma attacks, various pains).Sudden interference with bodily functions (temporary) - buzzing in ears, inability to speak or hear, sudden severe headache, hypersensitivity in hearing or touch, sudden chills or overwhelming heat in body, numbness in arms or legs, temporary paralysis.
Note: A few symptoms may not indicate demonic oppression...but these are very common symptoms for those under demonic attack.. After all there is really nothing to lose by doing so, except one's pride. When in doubt ... cast them out!

>> A person may experience more symptoms after researching/seeking deliverance. This is because the demonic spirits know they are being made known and come out of hiding more than usual. Don't be scared they can't hurt you. Rebuke all spirits of fear if you start to feel uneasy. While waiting for your appointment pay attention to your symptoms, thoughts, and dreams: Write down anything of notice and let us know about it at the start of your session. The spirits will often get riled up knowing they will be kicked out soon, and end up giving themselves away in the process. If you need any help or resources while you wait for your appointment, please reach out.
Additional comments
Before Coming For Deliverance:
There is something you can do to help bring about your freedom. I recommend that you deal with these issues before coming for deliverance.

In order for the deliverance to be successful there can be NO unforgiveness in your life. Unforgiveness is legal permission for demons to torment believers: Matthew 18:23-35. Do not neglect the area of forgiveness for yourself. You must also forgive yourself in order to be free. A typical prayer might be as follows:

"Father, because You have forgiven me I choose to forgive others, everyone who has hurt me, lied to me or disappointed me, I forgive. I confess unforgiveness as sin and repent of it. I receive Your forgiveness and apply it my life by forgiving myself. Thank You for Your grace and mercy in Jesus Name. Amen."

If there was ever any involvement (however innocent), in Satanic activities, witchcraft, cults or occult activities they must be renounced. Typical prayer:

"Father, I renounce any bond, or agreement I ever made with Satan and the kingdom of darkness. I know there can be no valid contract with a liar and I renounce any words, oaths or pledges made to Satan and I choose to be totally free from them. I choose to be cleansed from any ties with Satan in Jesus Name. Amen."

Sexual relationships outside of marriage...are called "Soul Ties" and each one could be an entry point for demon spirits. The ties must be broken by confessing them as sin and choosing to be free from them. I will include a prayer you can pray. It would be best if you could do so by denouncing each one by name, do the best you can with that. The deliverance process involves canceling permission of evil spirits to be in our life. This prayer and renunciation will cancel consent that was granted through soul ties. The prayer can be something like this:

"Father, I confess the sin of sexual relations outside of marriage. I renounce that sinful activity in Jesus' Name. I call back that part of me that was given to another, and I refuse that part of another that may have come to me. I denounce soul ties with them and choose to be free in Jesus Christ' Name. Amen"

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