Spiritual Profile Form YOUR POSTCODE or PID CODE Email ( to receive a copy, we need your email address) Marital Status - Select -SingleMarriedDivorcedEthnicity How long have you been a born again Christian? 0-5 years 5-10 years 10-15 years 15 - 20 years 20+ yearsPreviousNextHave you ever been through a spiritual healing/ freedom encounter like this before? YesNoUnsureIn the last 6months, how would you describe your relationship with God? Reasonably ok Not in a great place GreatPreviousNextWhat is/was your relationship with your Father? Good Could be better Not good at allWhat is/was your relationship with your Mother? Good Could be better Not good at allWhat is/was your relationship with your Step Mother? Good Could be better Not good at all Doesn't apply to meWhat is/was your relationship with your Step Father? Good Could be better Not good at all Doesn't apply to meDescribe what you relationship is like with your immediate family (parents, siblings, cousins etc) PreviousNextWere you conceived out of wedlock? Yes NoWere you adopted? Yes NoPreviousNextHave you ever practised any of the following(before or after becoming a born again Christian?) Astral Projection Astrology or reading Horoscopes Levitation Psychic Consultations Ouija Boards Seances Tarot Cards Transcendental Meditation Witch craft Yoga None of the abovePreviousNextHave you ever been engaged in/read any of these practices before or after becoming a born again Christian? Buddhism Agnosticism Atheism Hinduism Rastafarianism Afrikan Consciousness Sikhism Mormonsim Jehovah Witnesses Church of satan, satanic bible Scientology Edgar Cayce Books Islam/Koran Kabbalah Freemasonry (lodge) Santeria New Age Movement none of the abovePreviousNextDo you or have you suffered from any of these mental health disorders? Depression (mild) Depression (severe) ADD/ADHD Anxiety/Panic Disorder Bipolar OCD (obsessive compulsive) MPD/DID (multiple personalities) Schizophrenia none of the abovePreviousNextBriefly describe any long term PHYSICAL health conditions you may have (state 'none' if it does not apply) PreviousNextIn the last 6mnths, would any of these words describe how you have been feeling or are feeling? Depressed Insecure Traumatised Fearful Low self esteem Worthlessness Self condemnation Self hatred Bitterness Unforgiving Rejected Rage Revenge Hopelessness Distant from others None of the abovePreviousNextHave you ever done the following Had an abortion Self harm/cutting Attempted Suicide Any form of criminal activity None of the aboveHave you ever been addicted to any of the following before or after becoming a born again Christian? Alcoholism Drugs (incl. recreational) Food Gambling Prescription drugs Sleep Aids Tobacco Workaholism Sex None of the abovePreviousNextHave you ever participated in any of the following Adultery Same Sex relationship Transgenderism Bestiality Pornography Transvestism (Cross Dressing) None of the aboveAny of these things ever happen to you? Being raped Being molested Molested someone None of the abovePreviousNextList episodes of abuse, trauma, major accidents, or any other events that deeply affected you at age 0 -12yrs old (If none, please type 'n/a) List episodes of abuse, trauma, major accidents, or any other events that deeply affected you at age 13 -19yrs old (If none, please type 'n/a) List episodes of abuse, trauma, major accidents, or any other events that deeply affected you at age 20 -29yrs old (If none, please type 'n/a) List episodes of abuse, trauma, major accidents, or any other events that deeply affected you at age 30 -39yrs old (If none, please type 'n/a) List episodes of abuse, trauma, major accidents, or any other events that deeply affected you at age 40 -49yrs old (If none, please type 'n/a) List episodes of abuse, trauma, major accidents, or any other events that deeply affected you at age 50 -59yrs old (If none, please type 'n/a) List episodes of abuse, trauma, major accidents, or any other events that deeply affected you at age 60+ yrs old (If none, please type 'n/a) PreviousNextIn the last 2 yrs, have you ever noticed any of these things happening to you? Change in your voice that is unusual to you Something clawing inside your body Wanting to defile holy objects such as Bible/cross etc Convulsions/seizures that are not diagnosed and under treatment Feel a presence in your room or around you Foaming at the mouth Obscene outbursts Out-of-body experience See shadows/demons/ghosts Smell strange odors Bites, scorches on your body you cannot account for Feeling choked/unable to breathe when in prayer Feeling cold or surroundings becoming unusually cold Hearing growling sounds inside your head or body Incubus (demonic sexual intercourse with a male spirit) Succubus (demonic sexual intercourse with a female spirit Vomiting/coughing up phlegm in response to prayer None of the abovePreviousNextWhat do you want to achieve from attending these sessions and/or workshops? What are your greatest fears about your life? What do you think your weakness are and why? Describe what you relationship with your friends (distant/close, how many, who, why) PreviousNextAny other information would like to share, please use the space below Tick 1 that applies to you (the reason why we asked you to complete this form) I am a private paying client I am part of a BWSE soul restoration workshop held at my church I am currently a BWSE Academy Student I am booked as a Retreat Delegate Previous Submit Form
