Spiritual History

We ask that you provide the following information as completely as possible. Thank you for responding to all questions; we commit to maintaining complete confidentiality in handling all information. Once submitted, the form will be sent to our Director of Prayer & Healing Ministries, Martha Paulk, who will then get back in contact with you. Thank you!

Name *
Describe any difficulties your mother may have had during her pregnancy with you or difficult circumstances surrounding your birth, such as unplanned pregnancy, marital discord, social/cultural upheaval such as economic crises, war, etc.
Describe briefly each family member and your relationship with them (Father, Mother, Siblings):
If yes, please give details:
Please describe your relationship with Jesus, and church history:
Please describe any methods of seeking power outside of the Holy Spirit, such as fortune telling, Ouija boards, psychics, witchcraft, voodoo, etc. Include 1.) Degree from 1 to 5, 2.) Generational/Self, 3.) Choice or not (some children are brought into the occult by parents), and 4.) Satanic ritual abuse?
List anything you are aware of in your family tree that may separate you from receiving complete freedom (healing). Include repeated illnesses, addictions, patterns of sin, such as adultery, fornication, repeated calamities, early deaths, murder or suicides.