DELIVERANCE | FREEDOM FORM 

Please fill out the History form to prepare the team for their session with you.
Write “N/A”! (Not Applicable) or do not answer any area that does not apply to you.


The purpose of this form

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 anyone's 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, and births out of wedlock, and involvement in groups.



Note: 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.

Your Life

Any Involvement?



















Here are a few symptoms of demonic attack, please check any symptom that applies to you:


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

Note: A few symptoms may not indicate demonic oppression...but these are very common symptoms for those under demonic attack.. After all there is really nothing to lose by doing so, except one's pride. When in doubt ... cast them out!

Before Coming For Deliverance:

There is something you can do to help bring about your freedom. We 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. 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 sin and repent of it. I receive Your forgiveness and apply it my life by forgiving myself. 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 demon spirits. The ties must be broken by confessing them as sin 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 the best you can with that. The deliverance process involves canceling 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,"

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