Deliverance Request Form pre 2025 Please enable JavaScript in your browser to complete this form. Please enable JavaScript in your browser to complete this form. Name * First Last Email * Phone Number * What issues or problems led you to this Prayer Session? Describe your faith journey. What is your standing before God? Have you ever heard God’s voice or leading in any way? Are there any “blocks” or hinderances in your faith journey? Have you or your family members ever experienced the following? Physical Abuse Me My Family None Known Emotional Abuse – verbal abuse, manipulation, co-dependency, favoritism Me My Family None Known Sexual Abuse – rape, molestation, incest, unwanted touching, prostitution, trafficking Me My Family None Known Violence – beating, stabbing, gunshot, torture, murder, suicide, trauma, kidnapping Me My Family None Known Incarceration / Jail Me My Family None Known Addiction – alcohol, marijuana, drugs, pain meds, sex, pornography, gambling Me My Family None Known Abortion Me My Family None Known Relational Losses – sudden death, estrangement, abandonment, adoption Me My Family None Known Marital / Relationship Problems – separation, divorce, adultery, cheating Me My Family None Known Mental Health Problems – depression, anxiety, psychosis, eating disorder Me My Family None Known Cancer, Serious Health Problems & Lengthy Hospitalizations Me My Family None Known New Age Spirituality, Occult & Idolatry – fortune telling, divination, crystals, voodoo, hex, Santeria, blood sacrifice, tarot cards, witchcraft, sorcery, spells, incantation, yoga, shamanism, ancestor worship, freemasonry Me My Family None Known Please reflect on and describe any issues with Hurts Please reflect on and describe any issues with Fears Please reflect on and describe any issues with Guilts Please reflect on and describe any issues with Lacks Are there any unrepented sins and/or secrets in your life? In your family? Is there any bitterness or unforgiveness in your life? Are you aware of any curses, hexes and non-Christian “blessings” spoken over you or your family? If yes, describe in detail. Submit
