Care Team Form

Basic Information Section

Full Name

This address will receive a confirmation email

Phone

*Please type your Date of Birth in this format 31-12-1999

Date of Birth

Welcome to your Pre-Assessment

Have you suffered severe trauma or come from a broken home?

Yes No

Do you feel trapped in your own life or get overwhelmed with fear?

Yes No

Do you sometimes exhibit uncontrollable outbursts of anger or violence?

Yes No

Do you self-harm / cut or suffer anorexia/ bulimia/ insomnia?

Yes No

Do you suffer from or been diagnosed with Multiple Personality Disorder, Dissociative Identity Disorder, Obsessive-Compulsive Disorder, Bipolar, Borderline Personality Disorder, Attention Deficit Disorder, Attention Deficit Hyperactivity Disorder (ADHD) or Schizophrenia?

Yes No

Have you used drugs or excessive alcohol in the past or still do?

Yes No

Are you on medication? If yes – What are the side effects of the medication?

Yes No

Have you ever been involved with any of the following drugs? Psychedelic Drugs Hallucinogens Neurotoxins Ayahuasca Narcotics etc...

Yes No

Have you ever attempted suicide or have close relatives murdered or committed suicide?

Yes No

Do you hear voices? and/or telling/forcing you to commit illegal acts, blaspheme, or indulge in immoral acts?

Yes No

Do you suffer sleep paralysis or have nightmares?

Yes No

Spiritual Assessment - Additional Questions

Have you ever been involved with any of the following? - Witchcraft - Sorcery - Divination - Consulting of mediums - Channelling - New age practice etc.

Yes No

Are you oppressed or attacked by spirits? and or have suicidal thoughts?

Yes No

Have you suffered or suspect SRA - Satanic Ritual Abuse?

Yes No

Are you religious?

Yes No

Have you visited any other church(s) before?

Yes No

If yes, what did they say?

Do you give your informed consent to proceed with the deliverance session?

Yes No

Description

This Spiritual pre-assessment is vital for several reasons but most importantly it is crucial in helping us and you understand your spiritual state and identify areas that require spiritual attention. It aids in determining whether the condition is mental, spiritual, or both, thereby guiding us in how to best help.

Care Team Form

Description

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