1. Of the three components, body, soul, and spirit, I am aware that there are things I struggle with, which affect neither the body nor the spirit?
YESNO

2. Are you disappointed/frustrated about the way you think, feel or act towards certain situations?
YESNO

3. Do you experience difficulties making new friends and/or find it uncomfortable interacting with others in a group setting?
YESNO

4. Are you aware of any generational curses in your family or have you noticed any destructive patterns being repeated in your family (e.g., chronic sickness; barrenness and tendency to miscarry; breakdown of marriages and a family history of unnatural or untimely deaths)?
YESNO

5. Have you experienced (spiritual) torment (e.g., voices within your head); inability to think clearly; inability to sleep at nights, suicidal or any outrageous thoughts; or oppression of any kind?
YESNO

If so, please explain.

6. Have you had any involvement with the occult (e.g., witchcraft, tarot cards)?
YESNO

If so, please explain.

7. Have you experienced any childhood trauma or been subject to abuse of any kind?
YESNO

Please provide details.

8. Can you identify any pattern of thinking in your everyday life experience(s) that hinders you from experiencing a consistent “joy of the Lord” as promised in Holy Scripture?
YESNO

9. Do you struggle with a general sense of unforgiveness towards individual(s), and if so, do you find yourself “reacting” in an uncharacteristic manner to situations involving these parties.
YESNO

10. Do you experience persistent issues with “needing to be in control” of your life circumstances, and as a result, find yourself repressing/burying unpleasant memories, in an attempt to bury all associated emotional pain?
YESNO

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