Questionnaire

Name*

First Last

Address*

Street Address City State ZIP Code

Email*

Phone*

Questions

Do you believe that Jesus Christ came in the flesh as God and that His blood as sacrifice is sufficient to cleanse your sin?

What denomination or church affiliations have you had?*

In which denomination are you today?*

Who in your belief system do you admire?*

Do you think that the organization you have been a part of has met your spiritual needs? If yes, how? If not, how?

Do you believe that the husband is the head of the family or do you believe in co-leadership?*

Did you have a stable biblical example of parents while growing up?*

Do you read the Bible daily, weekly…….?*

Do your children read the Bible? How often?*

Are you or your spouse on any medication? If yes, which ones and since when?*

Do you believe that healing and miracles as in the Bible, are for today?*

Have you had any previous deliverance experience? Please describe. Which teacher?*

What kind of religious conferences –if any- have you attended?*

Marital Status*

Do you believe in Deuteronomy 28 about curses and blessings?*

Why are you contacting us today?