Your Free Spiritual Deliverance Assessment Form

📝 Deliverance Assessment Form

Welcome to your Deliverance Assessment Form. This is a safe and confidential space created to help you identify the root causes behind the challenges you're facing—whether spiritual, emotional, physical, financial, or relational. By filling out this form honestly, you are taking the first step toward healing and breakthrough. Every answer you provide will help us understand your unique situation and prepare a personalized plan to guide you into freedom. Take your time. You are not alone—this is the beginning of your deliverance journey.

Full Name *

Age *

Email Address *

Country *

Date of Birth

Gender *

Phone Number *

1. Marital Status: *

Single
Married
Widowed
Divorced

2. Religious Background:

Christian
Non-Christian

If Non-Christian, please specify Religion/Belief System:

3. Are you currently affiliated with a church or religious group?

If yes, please specify:

Section 2: Spiritual and Emotional Well-being

1. What are your primary concerns that led you to seek deliverance? *

2. Have you experienced any of the following? (Check all that apply) *

Nightmares or disturbing dreams
Unexplainable fears or phobias
Hearing voices or seeing visions
Persistent negative thoughts
Physical ailments with no medical explanation
Feelings of being cursed or hexed
Unexplained accidents or misfortunes
Addictions (e.g., substance abuse, gambling)
Emotional disturbances (e.g., depression, anxiety)
Unusual or erratic behavior
Family history of occult involvement or curses
Involvement in occult practices or other religions

Other (Please specify):

3. On a scale of 1 to 10, how would you rate your overall spiritual well-being? *

4. Have you sought spiritual or emotional help before? *

If yes, please describe the experience:

5. Are you currently undergoing any medical or psychological treatment? *

If yes, please describe the experience

6. Are you currently undergoing any spiritual Attacks *

If yes, please describe the experience and how long you have been facing the situation

Section 3: Christian-Specific Questions (If applicable)

1. How would you describe your relationship with God?

2. How often do you engage in the following spiritual activities? (Check all that apply) *

Prayer
Reading the Bible
Worship
Fasting
Fellowship with other believers

3. Have you ever experienced spiritual deliverance before? *

If yes, please describe the experience:

following? experience: would

4. Do you feel any resistance or fear when you think about God or Jesus Christ?

If yes, please describe the experience:

Section 4: Non-Christian Specific Questions (If applicable)

1. What spiritual or philosophical beliefs guide your life?

2. Have you ever participated in any form of spiritual cleansing or deliverance in your tradition?

If yes, please describe the experience:

3. Are you open to receiving spiritual guidance or prayer from a Christian perspective?

4. Do you have any concerns or reservations about participating in a Christian deliverance session? *

If yes, please specify: *

Section 5: Consent and Declaration

1. I understand that the deliverance process may involve spiritual guidance, prayer, and other religious practices. *

2. I consent to participate in the deliverance process, and I understand that this is a spiritual exercise, not a substitute for medical or psychological treatment. *

After submitting the Free Spiritual Deliverance Assessment Form expect the following process:

Confidential Review: The information provided is reviewed confidentially to understand the individual's spiritual needs.
Personalized Guidance: Based on the assessment, personalized guidance is offered to address specific concerns and spiritual challenges.
Deliverance Process: Clients are guided through a deliverance process, which may include spiritual guidance, prayer, and other religious practices
Ongoing Support: Support is provided throughout the journey to healing and deliverance.

Unlock Your Path to Deliverance

📝 Deliverance Assessment Form

Section 2: Spiritual and Emotional Well-being

Other (Please specify):

Section 3: Christian-Specific Questions (If applicable)

Section 4: Non-Christian Specific Questions (If applicable)

Section 5: Consent and Declaration

Click Below To Submit Your Deliverance Assessment

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