VRMI Deliverance Questionnaire

DELIVERANCE QUESTIONNAIRE
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
List all religions you or your family have been involved in:
A compulsive desire to blaspheme God.A revulsion against the Bible, including a desire to tear it up or destroy it.Compulsive thoughts of suicide or murder.Deep 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 door think.Compulsive desires to tear other people down, even if it means lying to do so. Vicious cutting 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. I.e. choking sensations, various unexplainable pains, 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 often ...recurring. Clairvoyant dreams that may even cometrue are most often demonic.Abnormal or perverted sexual desires.Questions and challenges to God's Word.Sleep or eating disorders without physical cause.Most compulsions and obsessions.Rebellion and hatred for authority.Bizarre terrifying thoughts that seem to come from nowhere and you cannot control them.Fascination with the occult.Involvement in criminal activity.Extremely low selfimage(unworthy, a failure, no good aconstant undermining of the selfidentity).Constant confusion in thinking (sometimes great difficulty in remembering things).Inability to believe (even when the person wants to).Mocking and blasphemous thoughts against preaching/teaching of the Word of God.Perceptual distortions perceivinganger, hostility, in others when it doesn't really exist seeingonly judgment inthe scriptures.Horrible nightmares causing fear (often having demonic images).Violent thoughts (suicidal, homicidal, encouraging selfabuse,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 and at significant times).Irrational fears panic attacks phobias.Irrational anger rage.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) Bipolar disorder.A strong aversion toward scripture reading and prayer (especially one on 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 you directly.Lying, exaggerating, or stealing compulsively (often wondering why).Drug abuse (especially when there is demonic hallucinations).Eating obsessions bulimia, anorexia nervosa.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 through body 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 are heard in the mind (they mock, intimidate, accuse, threaten or bargain).Voice refers to him/her in the third person.Supernatural experiences hauntings, movement or disappearance of objects, and other strange manifestations.Seizures (too long and/or too regular).Pain (without justifiable explanation especially in head and/or stomach).Blackouts.Physical 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.
**The information provided is of utmost confidentiality. This information will not be shared outside of VRMI ministry and no information will be disclosed at all under any circumstance.
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DELIVERANCE QUESTIONNAIRE