Prayer & Deliverance - The Cause Church

Your name *

Email address *

Phone number *

Address *

Do you attend The Cause Church on a regular basis? (2+ a month) *

Yes

How long have you been attending The Cause Church? *

On the day of your scheduled session, please do a partial fast.

Refrain from total fasting, but do a partial fast with things like a protein shake or bar, soups, etc. This will help you have more stamina and a clear mind. If you have never fasted food, we recommend consulting your physician.

Marital Status: *

Single

Married

Divorced

Widowed

If divorced, for how long and how many times?

Are you seeing a counselor? *

Yes, a Christian counselor

Yes, a secular counselor

I have in the past

Have you ever been checked into (against your will) or checked yourself in to receive a psychiatric evaluation or help? *

Yes

As a child

I've consider this as an option

Other

Relationship with parents *

What is/was your relationship with your parents like? If there was hurt, abuse, or neglect, please include that here.

Number of siblings, names & genders: *

Have you gone through a traumatic event? *

Physical Abuse

Sexual Abuse

Mental or Emotional Abuse

Spiritual Abuse

Death of a Parent(s)

Death of a Child

Death of a Loved One

Car Accident

Near Death Experience

Prolonged Sickness

Chronic Disease

Job Loss

Homelessness

Broken Engagement

Public Humiliation

Natural Disaster

Victim of a Scam

Bankruptcy

Other

Have you ever tried to attempt suicide or had suicidal thoughts? *

Yes

Other

If you checked yes, please elaborate: *

Have you ever deliberately hurt yourself? *

Self-harm in any form.

Yes

Other

Are you baptized in the Holy Spirit with the evidence of speaking in tongues? *

Yes

Requirements for being prayed over for deliverance:

Prior to scheduling an appointment, you must attend three consecutive services for the purpose of sitting under the deliverance anointing which is present when the body assembles. If after three services you have not received the deliverance you need, an appointment will be scheduled for you.

If you attend another church, you must have a letter from your pastor giving their permission. If possible, we would like your pastor to accompany you in the session.

1. Read: "Grace and Forgiveness" by John and Carol Arnott" &"Christian Set Yourself Free" by Graham Powell.

2. Fill out DELIVERANCE QUESTIONNAIRE.

3. Pray daily repenting of all known sins, renouncing all evil spirits and commanding them to leave. Continue this as often as possible until the day of your appointment.

4. Prior to your first scheduled session, fast from food for two days or if you cannot do a food fast, fast from something else for five days. On the day of your scheduled Session, refrain from a total fast. Do a partial fast with things like protein shakes, protein bars, soups, etc. This will help you have more stamina and a clear mind! If you have never fasted food, we recommend consulting your physician.

5. Dress modestly for the appointment.

6. In the final box of this form, type out a Brief Summary (1-2 paragraphs each) of your life as a small child, a teenager, and the present. Please include any events in your life which may have caused a change in your lifestyle (such as a marriage, the birth of a child, etc.) and any traumatic happenings that have had an impact on your life. Also, type out a summary of the problems you are experiencing and what you hope to achieve during deliverance.

ALL OF THE ABOVE REQUIREMENTS MUST BE COMPLETED PRIOR TO THE DAY OF DELIVERANCE OR YOU WILL BE RESCHEDULED FOR ANOTHER APPOINTMENT.

All information will be kept confidential.

SPIRITUAL INVENTORY

Demon spirits (the "powers" of evil that Scripture says we wrestle against) have descriptive names or titles that signify their functions, or areas in which they exert their influence over us. Thus, many evil spirit's names, or the descriptive titles that they may answer to, are the names of "evil emotions."

Demon spirits may also encourage compulsions, addictions, and irrational, destructive behaviors. God's Word teaches us that when our lives are pleasing to the Lord, that we are surrounded by a spiritual "hedge" of protection. We see this clearly portrayed in Satan's complaint to the Lord that God's "hedge of protection" made Job impervious to the devil's attacks.

"YOUR HEDGE OF PROTECTION HAS KEPT JOB AND HIS HOME AND HIS PROPERTY FROM ALL HARM. YOU HAVE PROSPERED HIM IN EVERYTHING HE DOES-LOOK HOW RICH HE IS! NO WONDER HE WORSHIPS YOU!" (Job.1:10)

This "hedge" of divine protection, however, can be breached, or broken through involvement in occult activities, illicit sexual intercourse, rebellion against God-ordained authority figures, unforgiveness, and certain other acts of willful disobedience to God, and persistence in sin. In any such case, this breach in the hedge of divine protection makes us vulnerable to "demonic influence" in our lives. This is precisely what Scripture warns us about in Ephesians 4:27 where we are warned not to "give the devil an opportunity against us," for when we do, we can be certain that "the serpent will bite us!"

"WHOEVER BREAKS THROUGH THE HEDGE WILL BE BITTEN BY THE SERPENT:" (Ecclesiastes 10:8)

Understanding this, please carefully consider where there may be "breaches" or holes broken through the "hedge" of divine protection around your life! Then, (on the last page of the packet) underline each word that represents an area that you have struggled with in the past or that is still a significant problem to you.

When you have finished the Spiritual Inventory (on the last page) go through it a second time and repent and ask the Lord for forgiveness for each word you underlined. You must speak the words out loud. This takes it from the natural to the spiritual so that the work can be done. (I Cor. 15:46). Then make a list of spirits that you would like to be delivered from.

DELIVERANCE QUESTIONNARE

With each question that is asked, you are to break the negative and then ask God to reverse what occurred and speak the opposite into the situation.
You are to forgive yourself as well as other people.
It would be beneficial if you went through the questionnaire once and then a couple of days later review the questions and ask the Holy Spirit if there is more forgiveness that needs to be done. When you are dealing with generational issues this is a prayer that you can pray.
“Lord, I ask you forgive me and my ancestors on both sides of the family for participating in the sin of I break off this sin going back to the beginning of time. Lord, I ask your cleansing power and healing over this sin of. and I bring this cleansing forward from the beginning of time to me and my children and grandchildren down to a thousand generations. Thank you, Lord. Another way you can pray this is to cut the umbilical cord of sin. I like this one. I think it has more power.”

Is there anything unusual about your birth? *

Premature, breech, cord wrapped around your neck, etc. If so, please explain?

Are you named after anyone? *

Relative or friend? If so, does this individual have any negative qualities? Break off the negative qualities.

What is your heritage? *

Irish, Native, etc. Are there any special activities with your heritage? Break off the negative qualities.

Is there anyone in your life that you struggle to forgive? *

Yes

Other

If so, who are you struggling to forgive or what situation are you struggling to forgive? *

Go through the next questions, and forgive the people involved in the different situations.

Ask the Lord to bless these individuals as you forgive them.
- Sex outside of a marriage relationship? Go before the Lord, name each person, repent, ask forgiveness, and break the soul tie. If you can't remember the names say, 'Lord, you know the name or the incident' then repent, ask forgiveness, and break the soul tie.
- Negative emotional soul ties. A relationship based on control or manipulation. Name the individuals, forgive them, and break off the soul tie. Then ask God to reverse the words that were spoken, and the actions done, and to bring forth something positive.
- Have you ever cursed anyone, or been cursed by anyone? Have you been painfully teased or harassed by someone? Examples would be being called stupid, fat, or ugly. If so, pray and ask God to break the words you have spoken over others, or that have been spoken over you.
- Have you honored your parents? "Honor your father and mother, as the Lord your God has commanded you, that your days may be prolonged, and that it may go well with you on the land which the Lord your God gives you" - Deut. 5:16. Jesus is the only perfect person. We have all dishonored our parents in one way or another. Repent and ask for forgiveness. Pray and get some leading from the Lord as to whether you should call your parents and ask for forgiveness. It is imperative that your attitude and heart are right. Then ask the Lord to bless your parents. This may be difficult, or take some time if you have been abused by your parents.
- Are you doing the same thing that you have judged in another person? "Therefore, you are without excuse. Everyone of you passes judgement, for in that you judge another, you condemn yourself; for you who judge practice the same things." - Rom 2:1. Judging others allows a root of bitterness to come in. If you have, ask for forgiveness, and then pray for the person you've judged. Lay an axe to the root of bitterness, release unmet expectations, and ask the Lord to bless the person(s).

Occult Background History *

The following information will help guide the team in praying for your deliverance.
Have you ever sought guidance or information from any of the following (even if only lightly, or playfully)?

Seance

Palm readers, fortune tellers

Tea leaves

Crystal ball

Automatic writing

Handwriting analysis, graphology

Horoscope, sign of zodiac

Spirit guide/channeling

Ouija board

Levitation

White Magic

Astral Traveling

Sorcery, witchcraft, familiar spirits

Clairvoyance/power to perceive beyond the human senses

Inner healing without God, based on one's mind, etc.

Deja'vu/reincaration belief

Chain letters for good or bad luck

Mind Control- mental telepathy, psycho kinesis, etc.

Hypnosis

Psychic Healing

Yoga

Harassment by psychic means

Non-Christian Exorcism

Voodoo spells, putting a hex on others, or a hex put on you

Transcendental meditation

Dungeons and Dragons (or other role playing games)

Manipulation with/without psychic means

Involvement with in pagan worship/temples, ceremonies or dances

Satanic worship or practices

Other

Negative Emotions *

Please check which emotions you've experienced frequently (more than once or twice, here and there)

Laziness, procrastination

Wrong self-image, self-condemnation

Jealousy

Suspicion

Argumentative attitude

Depression, discouragement, loneliness

Bitterness

Murder (violent attitudes)

Rejection, fear of rejection

Impatience, restlessness

Anger, cursing

Pride, vanity

Hatred

Religious Pride

Prejudice

Fears

Ungratefulness

Unbelief

Retaliation

Anxiety, insecurity

Rebellion, stubbornness

Other

If you checked any of the above boxes for negative emotions please elaborate: *

Have you committed yourself to a secret society? *

yes

Have you made a blood-pact? *

yes

Have you ever denied the divinity, virgin birth, or the resurrection of Christ; been involved with any religious groups which deny Jesus, the power of His blood, or the trinity? *

yes

Have you ever been involved with drugs? *

Marijuana

Cocain, heroin

Tranquilizers/sedatives (Valium, etc)

Amphetamines

LSD, other hallucinogenic drugs

Other

Are you currently taking any drugs/medication? *

Please describe if so, or answer no if not.

Do you watch or listen to anything that condones walking after fleshly or sinful desires? *

Pornography

Music

Movies

Reading material

Other

Have you ever in engaged in, or been forced to participate in any of the following sexual deviations? *

Fornication

Rape

Incest

Abortion

Lust

Adultery

Bestiality

Child molesting

Social media/online/other pornography

Other

Have you ever deliberately harmed someone else? *

Fighting, hitting, throwing items at a person, etc.

Yes

Other

If so, please elaborate.

Other possible bondages *

Ancestral background

Parent/child difficulties

Interpersonal disputes

Financial problems

Sibling rivalry

Illegtimacy

Other

Do you have dependencies or compulsive habits? *

Gambling

Impulsiveness

Biting fingernails

Gossip, slander

Stealing

Fantasies

Self-harm

Eating disorder

Alcohol addiction

Other

Have you ever? *

Had a death wish for yourself or others?

Suicidal or homicidal thoughts?

Harmed or cut yourself?

Dealt with mental illness

Other

Please list any other known problems below

Please tell us breifly about your life and significant experiences. *

Type out a Brief Summary (1-2 paragraphs each) of your life as a small child, a teenager, and the present. Please include any events in your life which may have caused a change in your lifestyle (such as a marriage, the birth of a child, etc.) and any traumatic happenings that have had an impact on your life. Also, type out a summary of the problems you are experiencing and what you hope to achieve during deliverance.