"The Primary Factor dictating our level of encounter with God is the measure of our hunger and sacrifice"  A.W. Tozer

A Midwest Regional Prayer Missions Base built through passionate hearts across the Midwest, dedicated to Night and Day Prayer and Worship to Jesus Christ.

MIDWEST REGIONAL INTERCESSORY PRAYER MISSIONS BASE

             

Spiritual Healing Questionnaire - Evaluation

A.  PERSONAL INFORMATION

1.  Name:      

 

B.  TRAUMA

 

 

 

 

 

 

 

C.  FAMILY 

 

 

 

 

 

 

 

D.  HEALTH

 

 

 

 

 

 

 

E.   FEELINGS & EMOTIONS

 

 

 

 

 

 

 

 

 

F.  FEAR

 

 

 

 

 

 

 

 

G.  HABITS

 

 

 

 

 

 

 

 

H.  LUST 

 

 

 

 

 

 

 

 

I.  WITCHCRAFT & OCCULT  

 

 

 

 

 

 

 

J.  FALSE RELIGIONS & CULTS 

 

 

 

 

 

 

 

K.  SECRET ORGANIZATIONS   

 

 

 

 

 

 

 

L.  OTHER  

 

 

 

 

 

 

 
Seeking His OIL, not our LAMPS - Matthew 25:7-9

Copyright © 2005 Wind and Fire Ministries Inc. Marion, IA All rights reserved.