Deliverance and Inner Healing Form

Short Creek’s Oppression and Inner Healing Form

Form Instructions:

Please fill out the Pre-Deliverance History form to prepare the deliverance team for their session with you. Write “N/A” (Not Applicable) in any area that does not apply to you.

Please use additional paper if required and record the Question Number with your answer.

Please sign the Liability Release at the bottom of the form.

All information that you provide is strictly confidential and will be viewed only by the individual(s) involved in personal ministry with you.

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Form Instructions:

Please fill out the Pre-Deliverance History form to prepare the deliverance team for their session with you. Write “N/A” (Not Applicable) in any area that does not apply to you. Please use additional paper if required and record the Question Number with your answer. Please sign the Liability Release at the bottom of the form. All information that you provide is strictly confidential and will be viewed only by the individual(s) involved in personal ministry with you

Date

Name

Gender

DOB

Profession

Education

Are you a “PRACTICING” Christian?

• Attending church regularly. – at least once a week. • Supporting a local church with your time and resources?

Doing your best to live a godly life with the New Testament being your guide?

Do you believe good people, like good Muslims, Buddhists, or Hindus, will go to heaven?

If you died right now, how confident are you that you will go to heaven?

If you are “Born Again,” when and where you “Born Again?”

Have you been baptized?

If so, when and where?

Are you a member of a local church?

Do you attend church regularly – at least once a week?

If not, why?

Does your church believe in deliverance for Christians?

Briefly Tell Us Why You Feel That You Need Deliverance

What area of your life do you think may be demonically influenced?

Orphan Curse – the issue of fatherlessness and addiction.

Romans 8:15-16 (NLT) So you have not received a spirit that makes you fearful slaves. Instead, you received God’s Spirit when he adopted you as his own children. Now we call Him, “Abba, Father.” 16 For his Spirit joins with our spirit to affirm that we are God’s children. 17 And since we are his children, we are his heirs. In fact, together with Christ we are heirs of God’s glory. But if we are to share his glory, we must also share his suffering.

• All addiction, all demonic influence, and all sin issues stem from the very first aspect of the curse, which preceded the fall of mankind. The curse of separation from Abba Father. We refer to this as the “Orphan’s Curse.” It is failing to understand the Love of Abba Father, His Grace, His Mercy, and His desire to have an intimate relationship with His children that leads to all the issues we have in the natural realm.

• This inherited curse that has affected all of humanity has been amplified by our relationships with first our biological fathers and then the other men in our lives that influenced us as we grew up. If we had godly fathers who raised us in the reverence of the Lord, the curse would be easily understood and overcome.

• However, if we were abandoned, rejected, neglected, or even abused spiritually, physically, or emotionally by our biological fathers and the other men in our lives, the curse becomes deeply rooted. It opens us up to be severely demonically influenced by all kinds of different demons and unclean spirits.

Signs you are dealing with an Orphan Spirit.

• The orphan spirit causes you to be overly sensitive and uncorrectable.

• The orphan spirit causes you to blow up relationships out of the fear of being rejected.

• The orphan spirit causes you to hide your own limitations.

• The orphan spirit causes you to perceive the strengths of others as competition.

• The orphan spirit causes you to secretly take satisfaction in the weaknesses and failures of others.

• The orphan spirit causes you to seek the attention of those in authority.

• The orphan spirit causes you to over-obligate yourself.

• The orphan spirit causes you to engage in people-pleasing behavior.

• Orphans live from fear. Fear has two twins: Guilt and Shame. Guilt from the past, shame for today. Shame is based on deception; the devil has convinced you that you are not who God says you are.

Are your parents divorced?

If so, how old were you, and briefly describe the details around the divorce.

Were you born or conceived out of wedlock?

Biological Father

Were you raised by your biological father?

Is your biological father still alive?

If not, when did he pass away, and how did he pass away?

How old were you when he passed away?

If he is still alive, how is your relationship with your biological father?

Was/is your biological father a “PRACTICING” Christian?

Does or did your biological father have any addictions? Alcohol, drugs, sexual, etc. – if so, please explain.

Did your biological father physically, emotionally, or sexually abuse you? – if so, please explain.

Did your biological father speak harshly/down to you? – you're stupid, lazy, fat, no-good, you will never amount to anything, etc. If so, please explain.

To your knowledge, was your biological father ever associated with the Freemasons, involved with any other secret society, engaged in the new age movement, or practiced any non-Christian religions (Catholicism, Islam, Wiccan, Buddhism, Hinduism, Mormons – Latter Day Saints, Jehovah's Witness, etc.), or any other pagan religions? If yes, please specify and elaborate.

Do you, or did you feel it was impossible to please your father/stepfather?

FORGIVENESS

The unwillingness to forgive, even the worst offense, is the enemy’s most prevalent entry point for demonic oppression.

Forgiveness doesn’t release the individual who harmed you; forgiveness releases you.

Matthew 6:14-15 (NASB) For if you forgive other people for their offenses, your heavenly Father will also forgive you. 15 But if you do not forgive other people, then your Father will not forgive your offenses.

Who do you have the most trouble forgiving, and why?

Do you often think of harm coming to those who have harmed, offended, belittled, bullied, neglected, rejected, or abused you?

Do you daydream of taking revenge on those who have harmed you?

Are you happy when those who have harmed you have bad things happen to them?

Are you unhappy when they do well?

On a scale from 1 – 10, 1 being you utterly detest yourself, and 10 being you love yourself; please rate how you feel about yourself

Please explain your answer.

Suicide – Self Harm (Check all that apply)

Ever considered taking your own life?

Is this something you are currently struggling with?

Have you ever made a written plan to take your life?

Have you or do you self-harm? (Eat until you are sick? Slap or punch yourself? Pull your hair or anything else that causes you harm?)

Does the pain bring you temporary relief?

If so, please explain:

Do you struggle with or have you ever struggled with lust, perversion, same-sex attraction, immorality, uncleanness, impurity, adultery, fornication, or pornography?

• Adultery – voluntary sexual intercourse between a married person and a person who is not his or her spouse.

• Fornication – sexual intercourse between people not married to each other.

Would you say you have an addiction to pornography?

How often do you view porn?

Are sexual thoughts something that you have often?

Do you view porn as a way to get back at your spouse?

How old were you when you were exposed to pornography?

If yes, to any above, please explain:

Please explain the events around your exposure to pornography.

Have you ever engaged in any form of witchcraft, sorcery, tarot cards, astrology, reading horoscopes, played demonic video games, read demonic anime, owned any crystals, owned a dream catcher, had crystal jewelry, or had an infatuation with horror movies? If so, please explain:

Have you had any affiliations with the Catholic Church, its paganism, and its idolatry? Or other pagan religions, Norse, Wiccan, Buddhism, Hinduism, Native American, etc.? If so, please explain:

Have you ever prayed to any other god (demon – Ba’al, Oden, Thor, etc.) than the Lord God Jehovah? If so, please explain:

Have you ever made a pact with the devil? If so, please explain:

Have you ever been associated with the Latter-Day Saints (Mormons) or the Jehovah's Witnesses? If so, please explain:

Have you ever had any association with the Masonic Lodge or any other secret society (fraternity or sorority)? If so, please explain:

Have you ever made an oath with the Lord? – For example – • “Lord, if you will get me out of jail and keep me out of prison, I will truly serve you.” Did you keep your oath? If so, please explain.

If not, please explain:

Do you have any occultic items in your home?

Harry Potter Books/Movies, Twilight Books/Movies, other occultic books or movies, non- Christian religious items; Buddha statue; other religious statues, including Catholic statues; etc., crystals, Ouija Board, evil jewelry; occultic card games, dream catchers, sage, soul tie objects – keepsakes from previous relationships, Ying Yang symbols, pictures or symbols of dragons and serpents, all Freemasonry Items, Native American symbols, pottery, and jewelry that serve as spirit guides, Symbols, books, and objects that represent the New Age, Symbols, books, and objects that represent witchcraft, Good-luck charms, secular music, Gifts, items, letters, and objects from your ex.

This is not a complete list, but it should help you remember any items that might be in your home.

Are you willing to remove these items from your home? If not, please explain

Do you have any unusual fears? Death, Demons, Snakes, Heights, Spiders, etc. If so, please list and explain.

Do you, or have you ever heard voices? If so, please list and explain.

On a scale from 1 – 10, 1 being extremely quiet and 10 being almost complete chaos, how loud and prevalent are the thoughts that run through your head?

What do you do to quieten the thoughts?

Please describe a few of the most disturbing thoughts.

Did you, or do you have an imaginary friend? If so, please list and explain.

Do you have trouble sleeping? If so, what do you use to get to sleep?

Do you have symptoms, coughing, joint pain, muscle pain, weakness, tingling, etc., that the doctors cannot seem to diagnose? If so, please list and explain.

Do you or have you ever had any sleeping disorders? If so, please explain.

Before Coming For Deliverance:

There is something you can do to help bring about your freedom. I recommend that you deal with these issues before coming for deliverance. In order for the deliverance to be successful, there can be NO unforgiveness in your life.

Unforgiveness is legal permission for demons to torment believers: Matthew 18:23-35.

True forgiveness isn’t possible without fully embracing the Grace of God by allowing the Holy Spirit to cultivate the Word of God as we make a verbal proclamation to forgive each individual who has wronged us.

Do not neglect the area of forgiveness for yourself; you must also forgive yourself in order to be free.

A typical prayer might be as follows: "Father because You have forgiven me, I choose to forgive others, everyone who has hurt me, lied to me, or disappointed me, I forgive. I confess unforgiveness as a sin and repent of it. I receive Your forgiveness and apply it to my life by forgiving! I Thank You for Your grace and mercy in Jesus' Name. Amen."

If there was ever any involvement (however innocent) in Satanic activities, witchcraft, cults, or occult activities, they must be renounced.

Typical prayer:

"Father, I renounce any bond or agreement I ever made with Satan and the kingdom of darkness. I know there can be no valid contract with a liar, and I renounce any words, oaths, or pledges made to Satan, and I choose to be totally free! From them. I choose to be cleansed from any ties with Satan in Jesus' Name. Amen."

Sexual relationships outside of marriage...are called "Soul Ties," and each one could be an entry point for demonic and unclean spirits. The ties must be broken by confessing them as sins and choosing to be free from them. I will include a prayer you can pray.

It would be best if you could do so by denouncing each one by name; do your best. Can with that. The deliverance process involves canceling the permission of evil spirits to be in our life. This prayer and renunciation will cancel consent that was granted through soul ties. The prayer can be something like this: "Father, I confess the sin of sexual relations outside of marriage. I renounce that sinful activity in Jesus' Name. I call back that part of me that was given to another, and I refuse that part of another that may have come to me. I denounce soul ties with them and choose to be free in Jesus Christ's name. Amen"

I hereby acknowledge and affirm that all answers given by myself in response to the questions in this form are voluntarily submitted and that the information is true to the best of my knowledge. I hereby release, indemnify, and forever hold harmless “The Church at Short Creek” and its agents, staff, employees, and volunteers of any damages, real or perceptual, arising from personal ministry in connection with the information submitted herein.

The Five Things that STOP Deliverance.

1. Unforgiveness.

2. Unrepentance.

3. Unbroken Generational Curses and Soul Ties.

4. Unsaved.

5. Unbelief.

Spiritual Disciplines to Maintain Your Deliverance.

1. Local Church Attendance, Support, and Involvement.

2. Daily Prayer Life.

3. Daily Bible Reading

4. Daily Bible Study.

5. Submit to Spiritual Leaders.

6. Regular Times of Fasting.

7. Avoid Triggers, places, people, things, that previously led you towards darkness.

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