Questionnaire Form

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2. Did anybody else in your family (siblings, ancestors, etc.) have a struggle with any addictions? If so, what? Who?

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

Part XIV: False religions

Examples of false religions: Buddhism, Hindu, Jehovah Witness, Mormonism, Christian Scientists, eastern religions, etc.

1. Have you ever been involved with any false religions? If so, why, when and how long? How do you feel about those beliefs now?

2. Have you ever been involved in any secret societies such as Freemasonry? If so, how deep were you involved?

Part XV: The Occult & Satanism

1. Have you ever shown interest in the occult? If so, in what ways? (Read up on it, dabbled in it, etc.)

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

3. Have you had any interest in horror or thriller style movies or novels? Are you still attracted to these things?

4. Have you ever made a vow with the devil? If so, what?

5. Married Satan?

6. Worshipped a demon or Satan?

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

8. Are you aware of any curses or spells placed on you? If so what? Who did it?

9. Dabbled with an Ouija board? If so, why?

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

11. Communicated with the dead? Explain.

12. Told somebody's fortune or went to see a fortune teller? Explain.

13. Ever read your horoscope?

14. Watched or been involved in a séance? Explain.

15. Been involved or a victim of Satanic Ritual Abuse (SRA)? Explain.

16. Been baptized into a false religion or any other evil baptism? If so, what were you baptized into? When?

17. Have you ever had a spirit guide?

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

19. Were you or anybody in your family superstitious? If so, who?

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

21. If you have made any vows or oaths, what are they? Were there any sacrifices or a ritual that was accompanied with them?

22. Have you ever made a blood pact before? If so, with whom (including persons, demons and Satan) and for what purpose?

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

24. Have you ever been involved in Yoga, transcendental meditation, or similar activities?

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

26. Any other involvement in the occult? Explain.

Part XVI: Un-confessed sins

1. Are there any un-confessed sins that you have not repented of? (Usually something you've done, that you know is wrong, but won't admit to it. An abortion, stealing, etc. are some examples.)

2. Is there anything you've been hiding inside that you haven't confessed?

3. Do you feel excessively guilty over some thing(s) you've done in the past? If so, what?

Part XVII: Cursed objects

1. Do you have any idols, occult rings, or anything that could hold evil spiritual value in your home? If so, what? Any objects that hold evil spiritual value must be destroyed.

2. Do you have any gifts saved from sinful relationships? If so, explain. For example, if a man gives a woman a personal gift during an adultery that needs to be sold or destroyed.

Part XVIII: Severe trauma, abuse & disassociation

1. Have you ever been exposed to extreme abuse or a traumatic experience? Did it have a drastic effect on your emotional or mental system? If so, what happen? How did it affect you?

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

3. Are you aware of any alters (other personalities) that you may have? (If so, tell me about them)