Call To Holiness Intl Ministry Inc

Diagnosis Form

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Name


First Name	Last Name

State

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Address


Address

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City	State	Zip Code

International Address

Phone

Phone Number

Email Address

1. What kind of bondage or sickness are you dealing with ?

2. Do you remember when the bondage or sickness started ?

3. What was happening around the time this bondage or sickness started ?

4. Were you involved in any sinful habits or activities that are contrary to the bible ?

5. What sinful activities or habits were you involved in, Prior to the bondage or sickness ?

6. Can you see any 'open doors' where the bondage or sickness may have entered through ?

7. Have you or your ancestors been involved in the occult or any false religions? Including secret societies such as Freemasonry and also seeking occult power or knowledge from others, such as having a fortune told, etc.

8. Do you have ancestors or family members who have suffered from a similar kind of sickness or bondage ?

9. How do you see yourself ? (Do you feel guilty, low self-esteem, confident, etc?)

10 . Is there anything in your life that has been troubling you for years, or is currently troubling you ?

11. Do you feel truly loved by God for who you are ? (Be honest!)

12. Did you feel loved by your biological father when growing up ?

13.What things have negatively impacted your life ? (Traumatic experiences, deeper sins, bad relationships, etc.)

14. What was your relationship with your parents like when you were growing up ?

15. Have you visited a psychologist, therapist, or mental institution for medication or mental health services?

16. What was your diagnosis ?

17. Have you ever received the baptism of water, or baptism of the Holy Spirit with the evidence mentioned in Acts 1:8, Mark 16:17, and Acts 2:32

18 Briefly describe to us how you came to faith in Jesus Christ

19. Do you understand that Deliverance ministry or healing can only work or be effective if you have a true relationship with Jesus Christ, or are willing to come into a close relationship with Jesus, and adhere to the spiritual instructions and principle

Select one

Yes
No

20. Do you admit that you personally sought for help for deliverance from CTHIM MINISTRY by your own volition and was not in any way coerced into this decision and will not sue or blame CTHIM MINISTRY or its entrusted ministers for services offered ?

Select one

Yes
No

I do Hereby admit by typing my name confirming my acceptance and willingness to go through bethesda house of healing. And that aforementioned facts are true about me .

Date

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Time

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