Deliverance Assessment Questionnaire
Instructions:This questionnaire helps identify possible areas of spiritual bondage or oppression. For each question, answer Yes, No, or Not Sure. Note: Some areas may touch upon sensitive or traumatic experiences; you only need to answer as you feel comfortable.
Name
First Name
Last Name
Email
example@example.com
1. Are you aware of any ancestors involved in the occult, secret societies, or unholy practices (e.g., Freemasonry, Eastern Star, etc.)?
Yes
No
Not Sure
2. Do you know of any generational patterns of mental illness, addiction, anger, or violence in your family line?
Yes
No
Not Sure
3. Are you aware of any ancestral involvement in practices such as divination, witchcraft, or spiritism?
Yes
No
Not Sure
4. Have you experienced any unusual fear or oppression that feels related to your family history?
Yes
No
Not Sure
5. Were you aware of any trauma your mother may have experienced during pregnancy with you (accidents, negative words spoken, etc.)?
Yes
No
Not Sure
6. Did you experience traumatic events in childhood, such as abuse, neglect, or feeling unwanted?
Yes
No
Not Sure
7. Do you recall unusual fears, recurring nightmares, or sensing dark presences in your childhood?
Yes
No
Not Sure
8. Did anyone in authority (parents, teachers) speak condemning or harmful words over you?
Yes
No
Not Sure
9. Have you ever used or been exposed to occult tools like Ouija boards, tarot cards, fortune-telling, astrology, or fascination with magic?
Yes
No
Not Sure
10. Have you read books or engaged with media (movies, music) related to witchcraft, occult practices, or dark themes?
Yes
No
Not Sure
11. Have you kept or currently possess objects that could have spiritual implications, such as crystals, foreign artifacts, or ritual items?
Yes
No
Not Sure
12. Have you ever participated in pre-marital sex, or felt a pull towards promiscuity or pornography?
Yes
No
Not Sure
13. Have you ever felt unexplained guilt, shame, or habitual thoughts that challenge your self-worth?
Yes
No
Not Sure
14. Have you ever been involved in or affected by others’ immorality, adultery, or sexual perversion?
Yes
No
Not Sure
15. Do you experience feelings of worthlessness, abandonment, or self-hatred?
Yes
No
Not Sure
16. Have you ever struggled with self-harm, suicidal thoughts, or deep hopelessness?
Yes
No
Not Sure
17. Do you suffer from recurring thoughts of rage, bitterness, or unforgiveness that you cannot overcome?
Yes
No
Not Sure
18. Do you suffer from irrational fears, panic attacks, or paranoia?
Yes
No
Not Sure
19. Do you have unexplained or frequent health issues with no clear medical diagnosis?
Yes
No
Not Sure
20. Do you experience frequent nightmares or feel a dark presence in your home?
Yes
No
Not Sure
21. Have you experienced physical symptoms that appear suddenly and have no clear medical cause (e.g., dizziness, seizures, or pain)?
Yes
No
Not Sure
22. Do you experience an aversion to prayer, reading the Bible, or attending church?
Yes
No
Not Sure
23. Do you feel deep guilt, fear, or anger when encountering spiritual activities or figures?
Yes
No
Not Sure
24. Do you ever feel like you are “losing time” or have experiences you can’t remember?
Yes
No
Not Sure
25. Have you ever felt or heard voices that intimidate, mock, or threaten you?
Yes
No
Not Sure
26. Do you struggle to trust others or feel a strong tendency to rebel against authority?
Yes
No
Not Sure
27. Do you feel plagued by doubts, unbelief, or thoughts that contradict your faith?
Yes
No
Not Sure
28. Do you have negative thoughts, jealousy, or hostility toward other believers or church leaders?
Yes
No
Not Sure
29. Have you or a family member ever been involved in occult practices, strange supernatural encounters, or criminal activity?
Yes
No
Not Sure
Submit
Should be Empty: