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  • Spiritual Inventory & Intake Form

  • All answers are given willfully and not under any pressure. We do not diagnose or treat mental illness. We do not make any recommendations regarding medications. We are strictly a Christian ministry and offer prayer ministry to free people from the influence of demonic spirits. We are mandatory reporters. While not required to receive ministry, there is a recommended donation of $200 per session because of the time invested.

    • Personal Information 
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    • Section 1 of 26

    • Preferred Meeting Times 
    • Section 2 of 26

    • SPIRITUAL INFORMATION 
    • Section 3 of 26

    • FAMILY HISTORY 
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    • Section 4 of 26

    • HISTORY RELATED TO ABUSE 
    • If you have dealt with abuse in the past, please put X in any box that applies to you. Please briefly explain in the space below

    • Section 5 of 26

    • HISTORY OF ABUSES, ACCIDENTS, TRAUMAS, ABANDONMENTS, OR VIOLENCE 
    • 1. List any episodes of abuse, trauma, major accidents, or any other events that deeply affected you.

    • Section 6 of 26

    • HISTORY RELATED TO ADDICTIONS 
    • Section 7 of 26

    • HISTORY RELATED TO DEPRESSION & MENTAL HEALTH 
    • Section 8 of 26

    • GRIEF & LOSS 
    • Section 9 of 26

    • Gifts, Powers, Prophecies, Curses 
    • Perspectives Concerning Your Life 
    • Section 10 of 26

    • SECRET SOCIETY, FRATERNITY, SORORITY, AMISH CHURCH, OTHER CHURCH MEMBERSHIPS, ETC. 
    • Section 11 of 26

  • Section 12 of 26

    • FAMILY PATTERNS 
    • Section 13 of 26

    • FEARS, NIGHTMARES, & NIGHT TERRORS 
    • Section 14 of 26

    • IDENTITY RELATED / NICKNAMES / ONLINE PROFILES 
    • Section 15 of 26

    • LIES 
    • Section 16 of 26

    • HISTORY RELATED TO OCCULT 
    • Section 18 of 26

    • OCCULT SYMBOLS / OBJECTS OF IDOL WORSHIP 
    • Section 17 of 26

    • Books, Shows, & Media that were Occult, Horror, Sexual, Etc Related 
    • Section 19 of 26

    • PHYSICAL HEALTH, ILLNESSES, & DIAGNOSES ISSUES 
    • Section 20 of 26

    • HISTORY RELATED TO ACCEPTANCE / REJECTION 
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    • SEXUAL HISTORY (GIVEN BY PERMISSION) 
    • Sexual History (given by permission)

    • TATTOOS 
    • Section 21 of 26

    • FAMILY RELATIONSHIPS - FATHER 
    • FAMILY RELATIONSHIPS - FATHER

      Please answer the following questions to the best of your ability. When given a choice, please designate the most accurate answer(s).
    • Section 22 of 26

    • FAMILY RELATIONSHIPS - MOTHER 
    • FAMILY RELATIONSHIPS - MOTHER

      Please answer the following questions to the best of your ability. When given a choice, please designate the most accurate answer(s).
    • Section 23 of 26

  • FAMILY RELATIONSHIPS - SIBLINGS

    Please answer the following questions to the best of your ability. When given a choice, please designate the most accurate answer(s).
  • Section 24 of 26

    • POSSIBLE DEMONIC ACTIVITY OR MANIFESTATIONS 
    • Section 25 of 26

    • FINAL THOUGHTS 
    • Section 26 of 26

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