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Application

To apply for a deliverance session, please fill out this form. Please note that filling out this form does not garuntee an appointment.

Is Jesus your Lord and Savior
Marital Status
Parental Status
Have you previously received deliverance/exorcism prayers?
Describe your relationship with GOD
Were you concieved in or out of wedlock?
Were you adopted?
Mark all that you have participated in
Mark books read, practices engaged in, organizations to which you or family members belonged.
Please mark any health issues that apply
Have you or a family been diagnosed with any of the following?
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