First Name *

Middle Name

Last Name *

Meaning of Each Name

Special event at Birth (For example were you presented to sun, water, dead ancestors, etc):

Are you properly married? YesNo

If “No” Please explain ...

Do you have children? YesNo

Is anyone of them spiritually challenged?

Do you read stars? (Derived from cosmic powers) YesNo

Do you believe and go to Palm Reader? YesNo

Is there any idol being worshiped in your family? YesNo

What are forbidden in your family?

Name of Grand Father

Meaning of Grand Father’s Name

Grand Father’s Religion & terms of worship

Name of Your Father

Meaning of your Father Name

Father’s Religion & terms of worship

Any other information about paternal generation

Name of Grand Mother

Meaning of Grand Mother’s Name

Grand Mother’s Religion & terms of worship

Name of your Mother

Meaning of your Mother Name

Mother’s Religion & terms of worship

Any other information about paternal generation:

Have you been to a native doctor? YesNo

If Yes Please Explain ...

Are there curses in the family? YesNo

If Yes, Please Write here ?

Have you practiced occultism? YesNo

If Yes, Please Write here ?

Have you been involved (or still active) in any illegal or spiritual sexual acts? YesNo

If Yes, please explain here

Have you been involved in any sexual perversion? IncestHomosexualBestialismMasturbationNo

Are you still in the act of sexual perversion? YesNo

If Yes. Please Explain ...

Are marriages in the family usually unsuccessful? YesNo

If Yes. Please Explain ...

Do you have uncontrollable sexual urges or thought? YesNo

If Yes. Please Explain ...

How is your dream life? (Seeing dead family, engaging sexual acts, etc) YesNo

If Yes. Please Explain ...

Any form of addiction in the family (Alcohol, drugs, etc)? YesNo

If Yes. Please Explain ...

Why do you need deliverance?