WFM-Freedom Questionnaire

1. ALL INFORMATION COLLECTED IN THIS QUESTIONNAIRE AND DURING THE SESSIONS ARE HELD IN STRICT CONFIDENTIALITY AND ONLY PRAYER STAFF HAS ACCESS TO THIS INFORMATION.

2. Please do not invite anyone to your Freedom session unless it has first been cleared with the Freedom Director, with the exception of minors whose parents may come if they desire.

3. Complete this to the best of your ability and with a heart of honesty and humility. Many of these questions you may have answers for and many you may not. We trust the Lord, through the Holy Spirit to reveal to you not only while you complete this, but also as we complete the session itself. The more information we have now, the less questions we will have to ask later.

4. Please understand that by simply checking a box that says you have experienced something or had a thought in a particular area, IT IS NOT AUTOMATIC OR INFERRED THAT YOU HAVE A SPIRIT AT WORK IN THAT AREA. It does, however, help us understand in what ways Satan has in the past or is planning to target you.

Do you understand the previous statements? YES / NO

PLEASE COMPLETE ALL QUESTIONS (approx 30 min.)

A. PERSONAL INFORMATION

1. Name: Address:

City, State Zip

2. Age: Phone: Email:

Church:

3. Marital Status: single married divorced remarried widowed

4. Do you have children? YES / NO

5. Do you work? If so whereDo you go to school? If so where

6. What is your prayer life like?

7. Is Repentance part of your Christian life? YES / NO

8. Do you have reassurance of your salvation? YES / NO

9. Have you been baptized in water or sprinkled? YES / NO

10. Have you been filled with the Holy Spirit or Speak in Tongues? YES / NO

11. Have you ever shaken, trembled, or fallen while being prayer for? YES / NO

B. TRAUMA

1. Has there been any traumatic experience in your life? (please check all that apply)

Sudden death of loved one	rape/molest	Fear	childhood	teenage	adulthood
Physical attack	psychic shock	shock due to accident	divorce	abortion	miscarriage
Other	Explain

2. Have you ever thought about suicide? YES / NO

3. Have you ever attempted suicide? YES / NOIf yes when/how?

4. Have you ever wished to die?YES / NO

5. Have you ever purposely caused physical damage/pain to yourself?YES / NO

6. Men only-have you ever been the father of a child that was miscarried or aborted? YES / NO

C. FAMILY

1. How is your relationship with your parents? any conflicts? YES / NO

2. How is your relationship with your siblings? any conflicts? YES / NO

3. Are your parents married? YES / NO

4. Are any of your family members Christians? YES / NO if yes who?

5. Was your father strong & manipulative or passive?

6. Was your mother strong & manipulative or passive?

7. Do either of your parents suffer from depression? YES / NO Whom?

8. Has any family member suffered from a mental problem? YES / NO Whom?

9. Describe your family’s financial situation when you were a child

10. Are you currently under serious financial distress? YES / NO

D. HEALTH

1. Are you currently taking medication (over the counter or prescription) YES / NO

If So, What are they and their dosages?

2. Do You suffer from any chronic illnesses or allergies? YES / NO

If So, which ones? Hereditary? YES / NO

3. Does your family have any medically diagnosed hereditary diseases or sicknesses? YES / NO

If So, What are they?

E. FEELINGS & EMOTIONS

1. Do you have trouble giving or receiving love? YES / NO

2. Do you find it easy to communicate with others? YES / NO

3. Do you or have you had any problems with the following (please check all that apply)

impatience	irritability	confusion	comprehension difficulties	A.D.D.	A.D.H.D
hardness of emotion	stubbornness	depression	moodiness	unpredictability	skepticism
rejection	abandonment	pride	doubt	unbelief	apathy
racial prejudice	resentment	jealousy	bitterness	rebellion	anger
temper/rage	violence	hatred	controlling	manipulative	overly passive
anxiety	worry	guilt	shame	condemnation	crying/sadness
Other	Explain

4. Are you easily frustrated? YES / NO

5. Do you show it or bury/hide it? YES / NO

6. Have you ever had psychiatric counseling? YES / NO Hospitalization? YES / NO

7. Have you had Shock treatment? YES / NO

9. Do you have mental blocks or trouble reading the Bible or Scripture? YES / NO

10. Do you day dream? YES / NO have mental fantasies? YES / NO

11. Do you suffer from frequent bad dreams? YES / NO Sleeplessness? YES / NO

F. FEAR

1. Have you ever had a strong & prolonged fear to any of the following? (please check all that apply)

failure	authority figures	rape	evil spirits	crowds	insanity
mans opinion	insects	pain	enclosed places	snakes	open spaces
inability to cope	the dark	violence	the future	heights	old age
public speaking	terminal illness	spiders	animals	loud noises	grocery stores
inadequacy	death	men	women	being alone	accident
death or injury of loved one	divorce	marriage breakup	dogs	water	flying in airplane
driving	rodents
Other	Explain

2. Since becoming a Christian do any of the above still grip you? If so which?

G. HABITS

1. Do you have any past or current destructive habits? (please check all that apply)

Lying	blasphemy	smoking	drinking	stealing	swearing
temper	coarse joking	anorexia	bulimia	criticism	gossip
gluttony
Other	Explain

2. Have you ever been addicted to the following? (please check all that apply)

Alcohol	smoking	food	compulsive exercise	gambling	being a spendthrift
T.V.	coffee	Drugs (prescribed or illegal)
Other	Explain

H. LUST

1. Do you have any recurring lustful thoughts? YES / NO

2. To your knowledge has there been lust in your parents or grandparents? YES / NO
3. Do you masturbate? YES / NO

4. Have you ever been molested or raped? YES / NO

5. Have you ever been a victim of incest? YES / NO

6. Have you ever been with a prostitute? YES / NO

7. Have you ever committed adultery? YES / NO

8. Have you ever had a homosexual or lesbian desire? YES / NO

9. Are you currently in an illicit sexual relationship? YES / NO

10. Have you ever sexually fantasized about an animal? YES / NO

11. Has pornography ever attracted you? YES / NO

12. Have you seen porn movies YES / NO videos YES / NO live sex shows YES / NO

13. Do you currently rent porn? YES / NO Do you currently have a porn tv channel? YES / NO

14. Do you currently look at internet porn? YES / NO

15. Have you been plagued w/ desire of having sex with children? (pedophilia) YES / NO

16. Have you had dreams of having intercourse? YES / NO

17. Do you currently have difficulty with perverse thoughts? YES / NO

I. WITCHCRAFT & OCCULT

1. Have you ever made a pact with the devil? YES / NO If so have you renounced it? YES / NO

2. To your knowledge has any curse been placed on your family? YES / NO

3. To your knowledge has any family member or relative been involved in witchcraft or occultism? YES / NO

Whom? Activity

4. Have you ever had any involvement with the following? (please check all that apply)

Fortune tellers	tarot cards	ouija boards	séances	Mind Gym	palmistry
astrology	color therapy	levitation	astral travel	horoscope	lucky charms
black magic	demon worship	spirit guide	crystals	Magic	astrology
realization	newage healing	metaphysics	physic phenomena	planchette	tea leaves
crystal ball	Clairvoyance	automatic handwriting	new age movement	native healer	curandero
ESP	telepathy	energy balls	good luck charms	amulets	martial arts
kabala	use of pendulum	divining	trances	acupuncture	spells
zodiac signs	yoga	mind control
Other	Explain

5. Have you visited any of the following? (please check all that apply)

Medium	witch or warlock	psychic	palm reader	crystal ball gazer	spirit guide
hypnotisms	fortune teller
Other	Explain

6. Have you ever had a life or reincarnation reading? YES / NO

7. Have you ever read books on witchcraft or occultism? YES / NO Do you still have them? YES / NO

8. Have you played any demonic games (D & D) YES / NO Do you still have them? YES / NO

9. Have you watched any demonic movies? YES / NO Do you still have them? YES / NO

J. FALSE RELIGIONS & CULTS

1. Have you or your family been in any cults? (please check all that apply)

Herbert W Armstrong	Hare Krishna	Buddhism	Meher Baba	Hippie-ism	Rosicrucians
Bahai	The third way	uni-church	Unitarian	inner peace movement	spiritual frontiers
fellowship	EST	ET	The way	transcendental meditation	the forum
MCC	Christian science	jehovah’s witness	gurus	mormon	moonies
Children of love	scientology	christadelphians	new age movement	religious communes	Native religions
eastern religions	Hindu
Other	Explain

K. SECRET ORGANIZATIONS

1. To your knowledge has any family member been a (please check all that apply)

Freemason	oddfellow	rainbow girl	eastern star	mormon	shriner
daughter of the nile	amaranth	job’s daughter	elk	demolay	Moose
Other	Explain

2. Have you ever been involved in the Masonic lodge YES / NO or any other society YES / NO

3. Has any of your family members ever been involved in the Masonic lodge YES / NO or any other society YES / NO

L. OTHER

1. Do you have any other problems that this questionnaire hasn't uncovered (explain as fully as you can. Try to pinpoint when they began and if each was connected with a trauma of some sort, if you were victimized, or if you invited the problem).

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

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