Deliverance Form (Extensive)

First and Last Name

Email

Phone

Join Newsletter?

Yes Email and Phone

No

Yes only Email

Yes only Phone

What part of the World or State do you live?

Personal Status

Have you ever had deliverance before? If so, how many times, and what was the name of the ministry? What were the issues you were dealing with? Or are you seeing a counselor and how long have you been in counseling?

Choose Your Issues

Demonic Attack

Witchcraft Attack

Feel Oppressed:

Persistent Addictions & Compulsions: Inability to break free from substance abuse, pornography, or destructive habits through willpower alone.

Mental & Emotional Torment: Severe depression, chronic anxiety, irrational fear, suicidal thoughts, or a persistent "cloud" over the mind.

Uncontrollable Anger & Rage: Sudden, explosive outbursts of temper or road rage that feel beyond a person's normal control.

Ungodly Soul Ties: Emotional or spiritual bonds remaining from past abusive relationships, illicit sexual encounters, or occult involvement.

Generational Curses & Inherited Patterns: Repeated family cycles of trauma, mental illness, divorce, or premature death attributed to ancestral baggage.

Occult or New Age Backgrounds: Coming to Christian faith from backgrounds involving witchcraft, voodoo, tarot, horoscopes, or alternative spiritualities where practitioners feel lingering dark attachments.

Spiritual Stagnation: Feeling blocked from growing in prayer, reading the Bible, or fulfilling a perceived calling from God.

Nightmares & Insomnia: Unexplained, chronic night terrors, sleep paralysis, or restless sleep with a dark or oppressive atmosphere.

Unexplained Physical Illnesses: Chronic pain, fibromyalgia, or sudden ailments that medical doctors cannot find an organic cause for, which are sometimes viewed as a "spirit of infirmity."

Involuntary Bodily Manifestations: Sudden shaking, twitching, burning sensations, or choking feelings that happen specifically during prayer, worship, or reading scripture.

Extreme Fatigue or Lethargy: An unnatural, heavy exhaustion that lifts completely outside of spiritual environments but hits heavily during church services or personal prayer time.

Paranoia and Voice Hearing: Hearing internal or external voices that mock, blaspheme God, or command a person to harm themselves or others.

Severe Self-Hatred and Mutilation: An overwhelming urge to self-harm, cut, or a deeply rooted hatred for one's own body and identity.

Sexual Perversion or Identity Confusion: Persistent, intrusive thoughts regarding taboo sexual practices, or a chaotic confusion about one's identity that resists counseling.

Paranormal Activity in the Home: Experiencing unexplainable shadows, moving objects, footsteps, cold spots, or a tangible sense of a dark presence in a living space.

Repetitive Tragic Cycles: A life pattern marked by constant, unusual "bad luck," such as sudden financial ruin right before breakthrough, recurring freak accidents, or unexplained relationship ruin.

Phobias and Irrational Fears: Intense, paralyzing phobias (like fear of the dark, crowds, or being alone) that do not stem from a known past trauma.

The "Spirit of Grief" or Heavy Heart: When grief or sorrow becomes chronic, paralyzing, and resists normal comforting, practitioners believe a literal "spirit of heaviness" (Isaiah 61:3) has attached itself to the broken heart and must be cast out.

Divorce and Hurt - History of divorce:

The Spirit of Rejection and Abandonment: This is often viewed as a foundational "root spirit." It tells the individual that they were not wanted, which can create a lifelong struggle to feel secure in relationships.

Identity Confusion: An adopted individual may struggle with a profound sense of not knowing who they truly are, leading to isolation or a feeling of being a perpetual "outsider."

Feeling Unaccepted or Unloved by God:

Other:

None Apply to me never involved

Other

Any diagnosis by doctor for illnesses that you want prayer for? Please list

Please list prescription subscribed by doctor or health provider?

Growing Up:

Adult Years

How I feel today about myself or think today

Any past regrets, or sins in the past you still replay today and still feel shame or guilt or cannot forgive yourself?

Did you have any traumatic events where you felt shock or horror or terror that caused you to be fearful on certain things or anxiety?

Yes

No

Other

You've been hurt by someone and feel resentment or bitterness? What did they do to you?

Have you been involved in the occult, new age, new age medicine any time in your life? Still involved. Pick

False Religion Practices

Any Manifestations and torment suffer from today.

What other new age, occult, religion not listed you need to add to the list? See list - https://www.touchofgod.org/post/occult-checklist

List words spoken over you that hurt growing up or today?

Do You Struggle with Fear?

I struggle with Envy and Jealousy

A spirit of accusation and Bitterness

Does your family have addictions?

Are you filling out the form for someone else?

Yes for my husband

Yes my child under the age of 16

No, filling it out for me

Core Beliefs in God in your actions

"God only loves me when I am perfect."

"I must work to keep my salvation."

"If I suffer enough, God will finally accept me."

"God is a harsh taskmaster looking for an excuse to punish me."

"My prayers are only answered if I do everything right."

None Apply

Core Beliefs - Performance Directed Toward Others (People-Pleasing)

"If I say 'no' or set a boundary, I will be completely abandoned."

"I am entirely responsible for everyone else's happiness."

"I must wear a mask because the real me is completely unlovable."

"My value is equal to what I can produce or achieve for you."

"I must never show anger or disagreement to be safe."

None apply to me

Core Performance Beliefs Towards Self

"Second place is total failure."

"I don't deserve to exist unless I am being productive."

"I must rely completely on myself because no one is coming to help me."

"My flaws define who I am."

"I am a burden to the world."

None Apply to me.

Do you have brothers and sisters and how is your relationship?

This is on self

When did you surrender your life to Christ?

Do you belong to a church?

Are you spirit filled and speak in tongues?

Yes

No

Anything else you want to share?

How did you find our ministry?