Questionnaire Form

Article Index


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:_____________________________________






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:________________________