Deliverance Questionnaire

If you are interested in setting up a deliverance appointment, please voulentarilly fill out all pages of the below questionnaire to the best of your ability. By filling this out, you are also acknowedging that should a ministry appointment be scheduled, you will also need to sign our general release agreement before any ministry can take place. 

Disclaimer: Filling out this form does not guarantee a ministry appointment.

Is Jesus your Savior?
Marital Status
I am currently under the care of a:
Parental Status
What is your:
Do you believe that you are demonically oppressed or possessed and do you want to be set free?
Are you willing to do what it takes to achieve this freedom?
Do you have any: