Questionnaire Form

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

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

Part XIX: Weaknesses

1. Do you struggle with any habitual sins? If so, what? Do you want to break those bad habits?

2. Do you struggle with any weaknesses such as lust, anger, hate, etc.? If so, what? Do you know where they came from or how they got started? Do you want to break free from those weaknesses?

Part XX: Pregnancy issues

1. Have you ever said something along the lines of, "I will never have children"?

2. Have you ever had an abortion or attempted one?

3. Have you ever had incest or ungodly sexual relations with somebody related to you? (See Leviticus 20:19-21, as this can cause a curse to land upon you which needs to be broken)

Part XXI: Other things to look for

1. Have you ever tried drugs? If so, how much, and how did it affect you? Why did you try drugs?

2. Have you ever thought about or attempted suicide?

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

4. Do you want, and are willing to be delivered? Are you willing to give up those demon spirits and maybe make some lifestyle changes in order to keep your deliverance?

5. Do you experience unusual confusion settle upon you as you try to pray and read the Bible?

6. What kind of music do you like? (Please list all styles of music you currently enjoy, and give examples in each category you list, such as some names of artists and songs)

7. Have you previously enjoyed hard rock, metal, acid, alternative, rap, new age, or any other kind of worldly music? (Please provide some examples of artists and songs from each genre (type/style) of music you list)

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

9. Have you ever been in a trance or had an out of body experience?

10. Have you ever noticed time slipped right out from under you? For example, you look at your watch and it's 7:00pm, then you look again what seemed like 15 minutes later and it's 2:00am. This is a sign of a trance.

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