Warfare Resume: Identifying

YEAR OF: Birth ____ Received Jesus ____ HS Graduation ____ Wedding ____

Are you on medication, a) now or b) previously (please circle one)

SPIRITUAL PROBLEMS WITH

___ Bible Reading

___ Church Attendance

___ Prayer

___ Spiritual Apathy

___ Witnessing

RELIGIOUS BACKGROUND

___ Catholicism

___ Christian Science / Scientology / Unitarianism

___ Far Eastern Religions / Hindu

___ Islam / Muslim

___ Jehovah’s Witnesses

___ Legalistic Abuse (Rules/Do’s  & Don’ts)

___ Mormonism

___ Native American Religion / Rituals

___ New Age

___ Pentecostal / Assembly of God

___ Religious Lodges (Masonic / Free Masonry / Shriners)

___ Rituals (Religious / Occult / Cult / Other)

___ Santeria

___ Other

___ Possess “cult” paraphernalia currently

I HAVE EXPERIENCED THE FOLLOWING

___ Charismatic Doctrinal Background

___ I have been slain in the spirit

___ I speak in tongues

___ I am willing to test the Tongue (1 John 4:1)

ADDICTIONS/SUBSTANCE ABUSE

___ Alcohol

___ Drugs / Prescriptions

___ Fitness / Over Exercise

___ Food / Overeating

___ Gambling

___ Rock Music / Rap / Heavy Metal

___ Tobacco

___ TV / Video Games / Computers

___ Ungodly Music CD’s / tapes / Videos / Pictures / Games in possession

___ Workaholic

___ Other

BEHAVIORAL CHARACTERISTICS

___ Anger / Hatred / Rage

___ Anxiety / Worry

___ Arrogance / Self Righteousness

___ Bitterness / Resentment toward others

___ Bitterness toward God

___ Controlling / Manipulative / Need for power

___ Critical Spirit / Gossip / Slander

___ Cursing / Swearing

___ Distrust / Lack of trust (of God / Others)

___ Fighting / Quarreling

___ Grumbling / Complaining / Discontentment

___ Hypocrisy

___ Independent

___ Indecisive

___ Impatience / Irritability

___ Isolation / Loneliness

___ Jealousy / Envy / Coveting

___ Lack of Submission to Authority Figures

___ Laziness

___ Lying / Deceit

___ Moodiness / Severe Mood Swings

___ Nightmares (If so, demonic? / or being “chased” in dreams?)

___ Panic Attacks

___ Prejudiced / Racist

___ Pride

___ Rebellious (toward God or others or both?)

___ Rejection / Abandonment

___ Self- Mutilation

___ Stealing

___ Suicide Thoughts / Attempts

___ Tendency to Blame others / Not take responsibility

___ Timid / Shy

___ Unforgiveness

___ Violent

MISCELLANEOUS

___ Adopted

___ Committed a crime / spent time in jail or prison

___ Excessive bed wetting when young

___ Financial Chaos (extreme debt)

___ Flashbacks of any kind

___ Have you lived in other Countries

___ Overwhelming Grief (i.e.: death of a loved one)

___ Tattoos

___ Trauma from an accident

___ Victim of Racism / Prejudice

___ Victim of any other kind of injustices

___ War Veteran

___ Other

OCCULT INVOLVEMENT

___ Astral Projection / Out of body Experience(s)

___ Astrology / Horoscopes

___ Auras

___ Automatic Writing

___ Blood Sacrifices / Pacts / Dedications

___ Channeling / Speaking with spirits

___ Charms / Fetishes / Crystals

___ Cult related paraphernalia in possession? (Books / Jewelry / etc.)

___ Curses (have you cursed someone or been cursed)

___ Do you have in your home symbols of idols / spirit worship

___ Do you possess pagan objects / Relics

___ Fortune Told / Palm Reading / Rune Stones

___ Have objects moved in your house without a source

___ Horror Movies (excessive interest)

___ Hypnotism

___ Levitation/ Table Tipping

___ Meditation (including through Martial Arts)

___ Numerology

___ Occult Books / Comics / Literature / Video Games

___ Occult related paraphernalia in possession? (Books / Jewelry / etc.)

___ Ouija Board / Crystal Ball

___ Participation in any Pagan / Occult Ceremonies

___ Psychic healing

___ Role Playing Games / D&D

___ Satan Worship / Witchcraft / Wicca

___ Séances

___ Spell Casting / Hexes

___ Spirit Guides / Imaginary “Friends”

___ Tarot Cards

___ Telepathy / Clairvoyance

___ Time Curses

___ Voodoo

___ White/ Black Magic

___ Yoga / Transcendental Mediation / Mind Control

___ Possess Occult Paraphernalia currently

FEARS  Primary Historical Fears (recent or past)

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KNOWN GENERATIONAL SIN

Father / Father’s Family Line

Mother / Mother’s Family Line

MENTAL/PSYCHOLOGICAL ISSUES

___ Acute Nervousness

___ Bipolar / Manic Depressive

___ Confusion / Concentration

___ Depression / Discouragement

___ Emotional Extremes (Happiness / Sadness)

___ Emotional Lack (Happiness / Sadness)

___ Extreme Forgetfulness

___ Hallucinations

___ Hearing voices in the mind

___ Hopelessness

___ Inferiority / Insecurity / Low Self Esteem

___ Memory Loss / Few memories from youth (good and/or bad)

___ Neglected (childhood / youth / adult)

___ Obsessive / Compulsive Behaviors

___ Perfectionist

___ Persecution Complex / Paranoia

___ Psychiatric / Psychological Counseling (for any reason)

___ Schizophrenia

___ Shame / Guilt / Condemnation

___ Trouble Giving or Receiving Love

___ Unbelief of God / Doubting God

___ Visions (of any kind)

___ Other

SEXUAL

___ Abortion

___ Adultery

___ Bestiality

___ Children born out of wedlock (you or YOUR child(ren)

___ Difficulty getting pregnant

___ Exhibitionism

___ Flirtatious / Seductive

___ History of Unfaithfulness (with or without intercourse)

___ Homosexuality

___ Impotence / Frigidity (lack of sexual desire)

___ Incest (including touching while playing “Doctor”)

___ Lesbianism

___ Lust / Fantasy

___ Masturbation

___ Molestation (done to you or you have done)

___ Pedophilia (child sex)

___ Pornography (including Internet)

___ Pre marital Intercourse / Immorality / Promiscuity (w/ others)

___ Pre marital Intercourse / Immorality (w/ SPOUSE)

___ Prostitution

___ Rape

___ Soap Operas / Romantic Novel (watch / read regularly)

___ Strip Clubs

___ Unwanted / Unplanned Pregnancies (YOU or you had)

Yes / No  Are you currently in a relationship?

If yes, for how long ____

Yes / No  Is the relationship currently free of all immorality?

If not, for how long ____

PHYSICAL PROBLEMS

___ AIDS

___ Cancer

___ Chronic Back Trouble

___ Chronic Fatigue / Fybromyalgia

___ Dizziness / Blackouts

___ Eating Disorders (Anorexia / Bulimia)

___ Frequent Illnesses

___ Headaches / Migraines

___ Hyperactivity / ADD / ADHD

___ Hypoglycemia / Diabetes

___ Joint Pain / Arthritis

___ Menstrual Problems / PMS

___ Miscarriages

___ Seizures / Epilepsy

___ Sinus / Throat / Ear Problems

___ Stress / Tension

___ Sudden Sleepiness / Insomnia

___ Teeth Grinding / TMJ

___ Tiredness / Exhaustion

___ Trauma at birth (YOU or you had)

___ Vision / Eye Problems

___ Other

ABUSE

___ Physical

___ Psychological / Emotional / Mental

___ Satanic Ritual Abuse (SRA)

___ Sexual

___ Spiritual / Religious

___ Verbal (“word curses”)

___ Other

FINAL SCREENING

RELATIONAL DIFFICULTIES

___ Father / Mother

___ Step Father / Mother

___ Guardians

___ Other Relatives (Grandparents / Aunts / Uncles / Cousins)

___ In-laws

___ Are you a child of a divorce situation

___ Have you been separated / divorced yourself

___ Relational Victimization

___ Other Relational Victimization

Father’s Name __________

Step Father’s Name __________

Mother’s Name _________

Step Mother’s Name _________

Guardian’s Name __________

Your Sibling’s Names / Ages (and any relational difficulties with them)

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