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Deliverance Questionnaire

If you are interested in setting up a deliverance appointment, please voulentarilly fill out all pages of the below questionnaire to the best of your ability. By filling this out, you are also acknowedging that should a ministry appointment be scheduled, you will also need to sign our general release agreement before any ministry can take place. 

Disclaimer: Filling out this form does not guarantee a ministry appointment.

Marital Status
Is Jesus your Savior?
Do you believe that you are demonically tormented, oppressed or possessed and do you want to be set free?
Parental Status
I am currently under the care of a:
Are you willing to do what it takes to achieve this freedom?
Ethnic/Cultural background: (please be as specific as possible)
Do you have any:
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