Questionnaire Form
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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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