00 Healing and Deliverance Questionnaire • Consuming Fire Ministries

CFM - Healing & Deliverance Questionnaire

*********Please Read Instructions Before Starting the Questionnaire**********

Welcome to the Conqueror's Healing & Deliverance Ministry. Before starting the questionnaire, please make sure you allot a minimum 1- 2 hours for completion. Should you have to stop at any time before completion, make note of stopping point and then scroll to the bottom of questionnaire and hit the submit button to submit what you have completed. Once you are ready to resume just start where you left off. When completed please submit your questionnaire. Thank you, Child of God! We can't wait to see you!

First Name *

Last Name *

Marital status?

Fiance' or Fiancee' name.

Spouse's name?

Other spouses name

Partner's Name:

Is your spouse interested in Healing & Deliverance?

Yes

How many children are in the household?

Phone Number *

Email Address *

Part I: The Bondage

1. When did the bondage (problem) start?

2. Were there any unusual things that took place (or you did) when this bondage started?

Yes

Please explain:

3. If this bondage started when you were a child: Do you have ancestors, siblings, or other relatives who have suffered from a similar kind of bondage?

Yes

Please explain:

4. What things have impacted your life? (Death of a parent, trauma, a certain situation that changed your life, anything that changed you.)

5. Did your bondage appear to have no reason to be there?

Yes

Part II: Soul Ties

1. Have you been involved with extramarital sex?

Yes

Are you attracted to an ex-lover?

Yes

Is he or she a good/Godly influence for you?

Yes

2. Have you been divorced?

Yes

3. Do you feel unusual attraction to a past boyfriend, girlfriend, or lover (who is not right for you)?

Yes

4. Do you let anybody dominate, control, or make your choices for you?

Yes

Who?

Why?

5. Have you ever formed a blood covenant with another person?

Yes

With whom and why?

6. Have you ever made vows or agreements with somebody in an effort to strengthen the relationship or commit yourself to one another?

Yes

Please explain:

7. Are there any ungodly relationships in your past where gifts were exchanged? (Like a picture of you with somebody you committed adultery with?)

Yes

Please explain:

8. Have you ever had ungodly relations with an animal?

Yes

Please explain:

Part III: Relationship with Parents

1. What do you think of your parents?

2. Did you feel rejection from your parents?

Yes

2a. Why did you feel this way?

3. How would you explain your childhood?

3a. Were you close to your parents while growing up?

Yes

Please explain:

3b. How would you explain your relationship with your parents?

4. Was either of your parents overly passive or controlling?

5. Has either of your parents been divorced?

Yes

5a. Remarried

Yes

Part IV: Rejection and Abuse

1. Were your parents married when you were conceived?

Yes

1a. Were you the right sex?

Yes

1b. Did your parents not want you, or want you to be a different (gender, etc.) in any way?

Yes

Please explain:

2. Did you feel rejection by your parents?

Yes

Please explain:

2a. Did you feel rejected as an adult?

Yes

Please explain:

3. Did you face abuse?

Yes

4. Have you faced rejection from your peers, classmates, friends, or those around you?

Yes

Please explain:

5. Have you ever been put down? Belittled? or made fun of?

Yes

Please explain:

6. If you faced rejection or abuse how did you respond?

6a. How do you respond to rejection right now?

7. Do you reject yourself? exam: (self-sabotage)

Yes

What is Self-Sabotage?

Please explain:

Part V: Unforgiveness or Bitterness

1. Is there anybody you feel edgy around? (Don't like, have no concern for, unable to love like Christ)?

Yes

Please explain:

2. Do you have anything against anybody?

Yes

Please explain:

3. Has anybody wronged you that you haven't forgiven from your heart? (thoughts, feelings, emotions, etc.)

Yes

Please explain:

4. Do you make a habit of blaming yourself for everything?

Yes

Please explain:

Do you have any hard feelings against them?

Yes

6. Do you obsess over your mistakes and feel unusually guilty for them?

Yes

7. Do you deeply regret things that you've done in your past?

Yes

Part VI: Personality

1. Are you a positive or negative person?

2. Do you feel confident in yourself?

Yes

3. Do you have low self-esteem?

Yes

What is Low Self-Esteem?

3a. Please explain:

4. Are you domineering or controlling?

4a. To whom:

4b. In what ways?

5. Are you an achiever? ( A go-getter)

Yes

6. Do you feel you are always right and that if everybody did everything your way, this world would be a better place to live?

Yes

7. How do you treat your children? Husband?

Children?

Husband?

8. Do you like people to 'look at you' (as in receive attention)?

Yes

Part VII: Emotional Health

1. Do you strive to feel accepted?

Yes

1a. How does this affect your lifestyle?

1b. By whom do you want to feel accepted?

2. Are you always stressed out?

Yes

Please explain:

3. Do you feel hurt?

Yes

Please explain:

4. Do you feel good about yourself?

Yes

Please explain:

5. Do you feel depressed?

Yes

5a. When did it start?

5b. What depresses you?

5c. Do you have siblings who are also struggling?

Yes

6. Do you struggle with fears?

Yes

6a. What is it that you fear?

7. Do you worry about things?

Yes

7a. What things do you worry about?

7b. Why?

8. Do you struggle with anger?

Yes

8a. Do you have a short temper?

9. Do you have any insecurities?

Yes

Please explain:

10. Do you feel any self-pity or feel sorry for yourself?

Yes

10a. Have you ever felt like this?

Yes

Please explain:

11. Do you find it easy to hate people?

Yes

11a. What kinds of things would a person have to do to make you hate them?

12. Do you have any irrational feeling?

Yes

Please explain:

13. Do you feel like there is something wrong with you?

Yes

Please explain:

14. Are you very confused and forgetful? (Beyond the normal)

Yes

Please explain:

15. Are you aware of any emotional wounds that have affected you?

Yes

Please explain:

16. Have you been deeply embarrassed over something?

Yes

Please explain:

17. Have you been in or are currently experiencing very difficult (depressing) circumstances which may cause you to feel hopeless or depressed?

Yes

Please explain:

Part VIII: Who are you in Christ? And how do you see God?

1. How do you explain your relationship with God?

2. Do you feel you aren't good enough to meet His standard?

Yes

Please explain:

3. Do you see Him as a loving father, or a dictator?

4. Do you believe that it's only by the Blood of Jesus that your sins are forgiven?

Yes

5. Do you feel God's love in your life?

Yes

Please explain:

6. Do you feel like your sins are forgiven?

Yes

7. Do you feel that doing good things, you earn God's love and acceptance?

Yes

8. Do you feel that God's is angry you?

Part IX: Spoken Curses, Vows & Oaths

1. Have you ever spoken something negative about yourself that has come to past?

Yes

Please explain:

2. Have your parents, or those in authority ever you spoken out a curse over you?

Yes

Please explain:

3. Have you ever made a vow out of anger?

Yes

Please explain:

4. Have you ever wished to die?

Yes

Please explain:

5. Have you made any vows or oaths?

Yes

Please explain:

Part X: Relationships

1. Do you have many friends?

Yes

1a. What kind of people are they?

2. Do you have a hard time trying to meet new people or make friends?

Yes

Please explain:

3. Are you socially outgoing or shy?

Yes

Please explain:

4. How would you define your relationship with your spouse?

5. How would you describe your relationship with your siblings growing up?

Please explain:

Part XI: Sexuality

1. Have you ever had unholy sex?

Yes

1a. What kind?

2. Have you struggled with any of the following: (Check all that apply)

2a. If any, please explain:

3. Have you been attracted to pornography?

Yes

4. Do you have homosexual thoughts and desires?

Yes

Please explain:

5. How do you feel about your sexuality?

6. Do you withhold sex from your spouse or you?

Yes

6a. Do you enjoy a healthy relationship with your spouse sexually?

Yes

6b. How does he/she react?

7. Have you ever been raped or sexually abused?

Yes

8. Have you ever awakened and felt a sexual presence with you? There is an (Incubus) and female (succubus) demon spirits that have sex with you while you're sleeping.

Yes

9. Do you struggle, or have you struggled with masturbation?

Yes

10. Have you struggled with any other sexual related thoughts, desires, or bondage?

Yes

11. Is there anything sexually that you are ashamed of?

Yes

Please explain:

Part XII: Addictions

1. Do you have any addictions?

Yes

1a. What kind?

1b. When did it start?

2. Did anyone else in your family struggle with addiction?

3. Have you ever had or currently have any sort of obsession over anything?

Yes

Please explain:

Part XIII: False Religions

1. Have you ever been involved with any false religions?

Yes

1a. Any others not mentioned?

1b. Why?

1c. When?

1d. How long?

1e. How do you feel about those beliefs now?

2. Have you ever been involved in any secret societies such as Freemasonry?

Yes

2a. If so, how deep were you involved?

2b. Was your Parents or Grandparents involved in Freemasonry?

Yes

Part XIV: The Occult & Satanism

1. Have you ever shown interest in the occult? i.e. (Read up on it, dabbled in it, etc.)?

Yes

2. Do you still feel drawn or attracted to the occult?

Yes

2a. In what ways?

3. Do you watch horror or thriller style movies or read these type novels?

Yes

4. Have you ever made a vow with the devil?

Yes

Please explain:

5. Married to Satan?

Yes

6. Worshipped a demon or Satan?

Yes

7. Have you ever put a curse or spell on someone?

Yes

8. Are you aware of any curses or spells placed on you?

Yes

Please explain:

9. Dabbled with the Ouija board?

Yes

Please explain:

10. Ever been a member of a coven (group of 13 witches)?

Yes

11. Told somebody's fortune or went to see fortune teller?

Yes

Please explain:

12. Ever read horoscope?

Yes

13. Watched or been involved in a seance? pronounced ˈsāˌäns.

Yes

14. Been involved or a victim of Satanic Rituals Abuse (SRA)?

Yes

15. Been baptized into a false religion or other evil baptism?

Yes

16. Have you ever had a spirit guide?

Yes

17. Have you ever been involved with meditation, yoga, karate, or related activities?

18. Were you or anybody in your family superstitious?

Yes

19. Ever been involved in astral travel? (Out of body travel)

Yes

20. Have you ever made any sacrifices or participated in rituals?

Yes

21. Have you ever made a blood pact before?

Yes

21a. With whom?

21b. Why?

22. Have you ever partaken in automatic writing, automatic drawing, or automatic painting?

Yes

23. Have you ever sought healing from a spiritual source other than Jesus Christ? (New age healing, energy healing, etc.)

Yes

24. Any other involvement in the occult?

Yes

Please explain:

Part XV: Unconfessed Sins

1. Are there any unconfessed sins that you have not repented of?

Yes

Please explain:

Do you feel overly guilty over something(s) you've done in the past?

Yes

Please explain:

Part XVI: Cursed Objects

1. Do you have any idols, occult rings, or anything that could hold evil spiritual value in your home?

Yes

Please explain:

2. Do you have any gifts saved from sinful relationships?

Yes

Please explain:

Part XVII: Severe Trauma, Abuse & Disassociation

1. Have you been exposed to extreme abuse or a traumatic experience?

Yes

1a. Did it have a drastic effect on your emotional or mental system?

Yes

1b. What happened?

1c. How did it affect you?

2. Have you ever been diagnosed with Dissociative Identity Disorder (DID) or Multiple Personality Disorder (MPD)?

Yes

3. Are you aware of any alters (other personalities) that you may have?

Yes

Please explain:

4. Do you have a memory gap where you can't remember a certain time of your life?

Yes

5. Do you have false memories of things that really didn't take place?

Yes

6. Have you ever been in a car accident or other traumatic situation?

Yes

7. Have you ever witnessed a tragedy in real life?

Yes

Part XVIII: Weaknesses

1. Do you struggle with any habitual sins?

Yes

Please explain:

1a. Do you want to break those bad habits?

Yes

2. Do you struggle with any weaknesses such as:

Please explain:

2a. Do you know where they came from or how they got started?

Yes

Please explain:

2b. Do you want to break free from those weaknesses?

Yes

Part XIX: Pregnancy Issues

1. Have you ever said things like, "I will never have children", or "My body has been cursed, that I can't have kids"?

Yes

2. Have you ever had an abortion?

Yes

3. Have you ever had incest or ungodly sexual relations with somebody related to you?

Yes

Part XX: Other things to look for:

1. Have you ever thought or attempted suicide?

Yes

Please explain:

2. Do you have any physical or mental disabilities, diseases, or illnesses?

Yes

Please List:

3. Do you want to be delivered?

Yes

3a. Are you willing to give up those demon spirits and maybe make some lifestyle changes to keep your deliverance?

Yes

4. Do you experience unusual confusion settle upon you as you try to pray and/or Bible?

Yes

5. What kind of music do you like?

7. Have you had any nightmares or weird experiences at night while supposedly sleeping?

Yes

8. Have you ever been in a trance?

Yes

9. Have you ever noticed time slipped right out from under you? exam: you looked at your watch at 7pm and then 15min later it's 2am? (This is a sign of a trance.)

Yes

10. Have you ever touched or kissed a dead body?

Yes

11. Do you feel that you somehow must earn your forgiveness?

Yes

11a. Do you wonder if your sins are truly forgiven, all of them?

Yes

11b. Are you aware of any signs of legalism or religious spirits operating in your mind?

Yes

Please explain:

12. Are you on any medications?

Yes

Please list:

13. Are you entertained by movies or tv shows which glorify death, murder, pain or suffering or others?

Yes

Please explain:

14. Have you ever had any other kind of weird encounter with the spiritual realm?

Yes

Please explain:

Yes

II Timothy 5:18

For the scripture says, Do not muzzle the ox when he treads out the corn. And, The laborer is worthy of his hire.

(ASV)

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