Freedom Session Form - Christ Alive Church

Your name *

Email address *

Phone number

Best time to meet? *

Week Days

Week Nights

Weekends

Other

Gender *

Male

Female

Prior Marriages? *

Yes

Were you the first born? *

Yes

Are you a Born-Again Christian? *

Yes

What church do you currently attend and how long have you been attending? *

Confidentiality Policy *

Please check the box if you consent to sharing all information shared in form with Christ Alive Pastoral Staff. This form will be utilized in your Sozo Session, and all information shared in the session and on this form is completely confidential and will be shared with no one.

Upon completion of your session, we delete this form.

Specific Questions

The purpose of this form is to help determine possible entryways for evil spirits. Obviously, generational/ancestral permission as forewarned in Exodus 20:5 is a possibility in anyones life. There are 30 ancestors in your history that could have passed a spirit on to you. Likely you only know about your parents and each of their two parents.

Please give any information that the Holy Spirit brings to your mind. Examples would be involvement with the occult, sexual perversion, alcoholism, depression or mental disorders, lots of divorce, adultery, anger, criminal activity, births out of wedlock, or involvement in groups such as Masonry, Eastern Star, Rainbow Girls, Oddfellows and Rebecca Lodge, etc.

It is not necessary to go into great detail with any of your responses. Ask the Holy spirit to show you any area of concern.

Are you aware of any ancestry involvement in any of these? *

Yes

From birth and your early childhood: Are you aware of any trauma you might have experienced during your mother's pregnancy? Accidents, divorce, spoken words such as "We shouldn't be having a child", etc.?

Do you recall any early childhood fears, injuries, nightmares? Do you remember seeing things in your room or feeling an evil presence? Do you recall any encounters of a supernatural kind?

Any sexual abuse or sexual embarrassment through childhood?

Do you recall any spoken words from parents, or others that were condemnation? Embarrassing or humiliating experiences at school or from a school teacher?

"You're fat; You're stupid; You'll never amount to anything; You always mess up; I don't know why we had you; You cant be in our group"; etc.

Any physical abuse from parents or others?

Involvement (however innocently it may have been) with Ouija boards, Magic 8 Ball, levitation games, seances, fortune tellers, tarot cards, astrology, horoscopes, fascination with books about magic, physics seers, Harry Potter books, Pokemon Cards, etc.?

Please list any accidents or injuries that come to your mind as being frightening to you at the time:

Please list surgeries and approximate age:

Movies or TV programs that were particularly frightening to you, or specific scenes that seem to stick to your memory:

Have you participated in pre-marital sex? *

Yes

Periods of habitual immorality? (including pornography, sexual fantasy, promiscuity, etc.)

Drinking and/or Drug use?

Do you experience unusual fears?

What do you think may be areas of demonic influence in your life?

Are (or were) there any significant problems in the home?

Are your parents divorced? *

Yes

Unusual feelings such as: Never really felt loved, couldn't please my father/mother, feelings of worthlessness. etc.?

Have you been exposed to Pornography? *

Yes

Please answer the following questions as they apply to your life:

Homosexual tendencies? *

Yes

Participated in college fraternities or sororities? *

Yes

Feelings of Guilt and Shame? *

Yes

Hopelessness? *

Yes

Fatigue without medical reason? *

Yes

Have you had or funded an abortion? *

Yes

Difficulty in forgiving? *

Yes

Do you experience feelings of self-hate? *

Yes

Have you suffered from self-harm? *

Yes

Do you have feelings of Gloom? *

Yes

Do you feel Rejected? *

Yes

Do you have any objects in your home or possession that relate to ungodliness or cults? *

This would include: New age religions, such as books about eastern deities, crystals, heavy metal music, Native American/African artifacts, Items connected with other religions or rituals, Wiccan or other occult items, etc.?

Yes

Have you ever "felt" a presence in the room? *

Yes

Do you have nightmares? *

Yes

Do you hear voices? *

Yes

Have you been diagnosed by a doctor as having: (list any diagnosis, diabetes, asthma, hypertension, etc.) *

Yes

Do you have any inexplicable pain, with no medical reason for it? *

Yes

Do you have difficulty trusting others? *

Yes

Has there been a death of someone close to you? *

Yes

Do you feel like you have any eating disorders? *

Yes

Do you suffer from sleep disorder? *

Yes

Any other medically defined disorder? *

Yes

Is there a history in your family of tuberculosis, diabetes, ulcers, cancer, heart disease, glandular problems, asthma, etc.? *

Yes

Did you have imaginary friends as a child? *

Yes

When attending church or other ministries do you have "foul" thoughts, jealousies or other mental harassments? *

Yes

Do you have difficulty retaining God's word? *

Yes

Difficulty reading it? *

Yes

Do you have consistent migraine headaches? *

Yes

Do you have any addictions? *

Yes

Were you ever diagnosed with a learning disability? (I.e. A.D.D. etc.) *

Yes

Do you have a fear of death? *

Yes

Have you ever had suicidal thoughts? *

Yes

Has there been a period of time in your life when you were angry with God? *

Yes

Do you suffer from anxiety or panic attacks? *

Yes

Do you feel incredible loneliness? *

Yes

Do you have a fear of losing your mind? *

Yes

Are you plagued with doubt and unbelief? *

Yes

Do you have thoughts of inadequacy? *

Yes

Do you have obsessive thoughts? *

Yes

Blasphemous thoughts? *

Yes

Compulsive thoughts? *

Yes

Do you feel inferior? *

Yes

Lustful thoughts? *

Yes

Do you daydream? *

Yes

Are you a perfectionist? *

Yes

Are things seemingly always out of order? *

Yes

Do you feel the need to be in control? *

Yes

Feelings of insecurity? (On a scale of 1-10 with 10 being the worst) *

Below are a few symptoms of demonic attack. Please check all that apply to you:

A compulsive desire to blaspheme God

A revulsion against the Bible, including a desire to tear it up or destroy it

Deep feelings of bitterness and hatred toward others without reason

Jews, other races, the church, strong Christian leaders, etc.

Any compulsive temptations, which seek to force you to thoughts or behavior which you truly do not want to do or think

Compulsive desires to tear other people down, even if it means lying to do so. Vicious cutting down of others by the tongue

Terrifying feelings of guilt even after honest confession is made to the Lord

Certain physical symptoms which may appear suddenly or leave quickly and there are no physical or physiological reason

Pains that seem to move around and for which there is no medical cause.

Feelings of tightness about the head or eyes

Dizziness, blackouts, or fainting seizures

Deep Depression or despondency

Sudden surges of violent rage, uncontrollable anger, or seething feelings of hostility

Terrifying doubt of ones salvation even though they once knew the joy of salvation

Seizures of panic or other fear that is terrifying

Dreams or nightmares that are of a horrific nature and often recurring. Clairvoyant dreams that may even come true are most often demonic

Abnormal or perverted sexual desires

Questions and challenges to God's word

Sleep or eating disorders without physical cause

Most compulsions or obsessions

Rebellion and hatred for authority

Bizarre, terrifying thoughts that seem to come from nowhere and you cannot control them

Fascination with the occult

Involvement in criminal activity

Extremely low self-image (unworthy, a failure, no good - a constant undermining of the identity)

Are you rebellious? *

Yes

Inability to believe (even when the person wants to)

Mocking and blasphemous thoughts against preaching/teaching of the word of God

Perpetual distortions - perceiving anger, hostility, in others when it doesn't really exist- seeing only judgement in the scriptures

Horrible nightmares causing fear (often having demonic images)

Violent thoughts (Suicidal, homicidal encouraging self abuse, etc.)

Hatred and bitterness toward others for no justifiable reason

Tremendous hostility or fear when encountering someone involved in deliverance work

Feelings of being watched or sensing an evil presence

Irrational fears - Panic attacks - phobias

Irrational anger - rage

Irrational guilt - self-condemnation to the extreme

Desire to do what is right (inability to carry it out)

Sudden personality and attitude changes (Severe contrasts - appears schizophrenic, Bi-polar disorder)

A strong aversion towards scripture reading and prayer (especially one on one)

A dark countenance (steely or hollow look in eyes - contraction of the pupils - sometimes facial features contort or change - often an inability to look at others in the eyes)

Lying, exaggerating or stealing compulsively (often wondering why)

Drug abuse (especially when there is demonic hallucinations)

Eating obsessions - bulimia, anorexia, nervosa

Compulsive sexual sins (especially perversions)

Irrational laughter or crying

Irrational violence - compulsion to hurt self and/or others.

Sudden speaking of a language not previously known (often an ethnic language of ancestors)

Reactions to name and blood of Jesus Christ (Verbally or through body language)

Extreme restlessness (especially in a spiritual environment)

Uncontrollable cutting and mocking tongue

Vulgar language and actions

Loss of time (from minutes to hours - ending up somplace, not knowing how you got there- regularly doing things of which there is no memory)

Extreme sleepiness around spiritual things

Constant confusion in thinking (Sometimes great difficulty in remembering things)

Demonstration of extraordinary abilities (either ESP or Telekinesis)

Voices are heard in the mind (they mock, intimidate, accuse, threaten, or bargain)

Voices refer to him/her in third person

Supernatural experiences - hauntings, movement or disappearance of objects, and other strange manifestations)

Pain (without justifiable explanation - especially in head and/or stomach)

Physical ailments can often be alleviated immediately by a command of spiritual authority (I.e. epileptic seizure, asthma attacks, various pains)

Sudden interference with bodily functions (temporary) - buzzing in ears, inability to speak or hear, sudden severe headache, hypersensitivity in hearing or touch, sudden chills or overwhelming heat in body, numbness in arms or legs, temporary paralysis

Seizures (too long and/or too regular)

Any Additional Comments/Questions/Concerns can be listed below:

*DISCLAIMER* *

BY TYPING YOUR NAME BELOW, YOU CERTIFY YOUR UNDERSTANDING THAT CHRIST ALIVE CHURCH IS NOT RESPONSIBLE FOR ANY PHYSICAL, MENTAL, OR SPIRITUAL ISSUES OCCURRING PRIOR, DURING, OR AFTER SAID SESSION.

General Information

Specific Questions

Please answer the following questions as they apply to your life:

Below are a few symptoms of demonic attack. Please check all that apply to you: