Due to overwhelming response, please complete the entire form below to submit your request for more information and scheduling.

 

PERSONAL HISTORY

Describe your family relationships when you were a child.
Answer all that apply.

SPIRITUAL HISTORY OCCULT/NEW AGE PRACTICES

Mark ones in which you have participated. If further explanation is needed, use the box.

RELIGIOUS LITERATURE, CULTS, NON-CHRISTIAN RELIGIONS, SECRET SOCIETIES

Mark books read, practices engaged in, organizations to which you or family members belonged.

PHYSICAL HEALTH

If you have a health issue, please mark box. If further explanation is needed, please do so in the box.

MENTAL HEALTH

If you are diagnosed with this condition(s), please mark box. If a family member, please indicate who.

EMOTIONAL/BEHAVIORAL PROFILE:

Mark boxes that best describes you.

TRAUMA OCCURRENCE(S)

List episodes of abuse, trauma, major accidents, or any other events that deeply affected you.
If none for an age section, please type "None"

DEMONIC BEHAVIOR & MANIFESTATIONS

Mark all that apply.