M.O.W.I. DELIVERANCE MINISTRY INC.

This information is voluntary and confidential and does not affect your legibility, for your deliverances. This may assist your deliverances, and your information is confidential.

First Name:_____________________________________

Last Name:_____________________________________

E-Mail:________________________________________

Phone:________________________________________

Mobile:________________________________________

Address:_______________________________________

City:____________________

State:________ Zip Code:_______________

Profession:__________________ Do you have a home church? ____ Yes / No____

Are you born again? ___Yes / No___, Am not sure ___, if yes when_____________

Do you want to accept Jesus as your Lord and savior? ____Yes / No____

Catholic __ / Anglican __;  Presbyterian __ / Baptist __; Pentecostal __ / Evangelical __;

Other __; None of the above __; Do you belong to a fellowship __Yes / No__.

How often do you read / Study / Meditate on the Word of God?

Daily __Yes / No__, if yes how often?_____________

Daily, if daily how many minutes at a time?_________

15 Minutes or more? __Yes / No__

For how long in real time?________                                                                                                                          

How many times a week do you meditate on yhe Word of God?_______________

Do you pray? __Yes / No__, If yes for how long?________ How often do you pray?____________

Spiritual Diagnosis:

Do you dream? __Yes / No__

If yes, do you remember your dream vividly? __Yes / No__

Do you Pray? __Yes / No__

If yes, describe briefly features of your dreams:________________________ 

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