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Center For the Nations
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as a sick person
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CASE STUDY FORM
COURTROOM DELIVERANCE MINISTRY
JESUS CHRIST HEALING CENTER FOR THE NATIONS
Date
Time
Hours
Minutes
AM/PM
AM
PM
PLACE
Name
Meaning
Date of Birth
Home Town
Father’s Name
Mother’s Name
Husband’s Name
Wife’s Name
Number of Father’s Children
Your Position
Grandfather’s Name
Grandmother’s Name
Ancestral Religion
Father’s Religion
Mother’s Religion
Ancestral History/GRAND PARENTS (Background)
Parental History/FATHER & MOTHER (Spiritual-Religious)
Parental History/FATHER & MOTHER (General)
Personal History(General)
SPIRITUAL BIRTH IN CHRIST
Are you born again in Christ?
Yes
No
When?
Where?
How?
Evidence?
Are you committed to the activities in the Church?
Yes
No
Have you gone through any deliverance in the Church?
Yes
No
Where?
How?
Evidence?
DEMONIC INITIATIONS AND COVENANTS
Have you ever visited a satanic medium?
Witch
Wizard
Witchdoctor
Magician
Sorcerer
Psychic
Traditional Healer
Fortuneteller
Soothsayer
Necromancer
Spiritualist
Fetish Priest
Yes
No
If yes, were you asked to perform any ritual as a result of visiting any of these places ?
Yes
No
Have you ever been involved in Occultism?
Yes
No
Have you ever been initiated into Occultism?
(Initiation into occultism means doing something which enables you to become an occult member.)
Yes
No
Have you ever been involved in practicing occultism?
Yes
No
Have you ever visited a shrine for any assistance?
(A shrine is a place of worship of a demonic deity.)
Yes
No
Have you ever visited a witchdoctor because of sickness or any problem?
Yes
No
Have you ever been asked by anyone to bring or sacrificed any kind of animal or bird because of your visitation to a satanic medium?
Yes
No
Have you ever witnessed the sacrifice of an animal or bird on your behalf?
Yes
No
Have you ever been taken to a riverside to bathe or do any demonic rituals?
Yes
No
Have you ever been asked by any Satanic medium to
Drink Holy water
Bath Holy water
Bath with special soap
Bath with concoction-mixture of herbs and water
Bath any form of liquid water
Used a special cream ☐Burn a special incense
used special anointed oil
Read special books
Yes
No
If yes, where did this happened ?
Have you ever been given any material object like a ring or necklace by any Satanic Medium to keep for:
Protection
Prosperity
Charm
Others
Yes
No
If yes, state what kind of protection, prosperity, charm or other purpose
Have you ever been taken to a forest, valley, mountain to perform any rituals on your behalf
Others
Yes
No
Have you ever been asked to make any vows to anything or person at any place at anytime in your life?
Yes
No
Have you ever recited any words after any satanic medium at any place at anytime of your life?
Yes
No
If yes, what words did you recited
Have you ever received any marks of incision on your body at any place at any time of your life?
Yes
No
Why did you receive those marks and for what did you receive them?
Have you ever made any tattoos on your body?
Yes
No
*Who made those tattoos?
Why did you make them?
SEXUAL LIFE - HUMAN WIVES AND HUSBANDS
How many sexual girlfriends or boyfriends did you date before getting married?
Did you make any promise to marry someone you didn’t fulfill?
Why did you fail to fulfill your promise?
Were you the one who broke the relationships or the other persons or whom?
What were the causes for the broken relationships?
DREAM LIFE
DEMONIC VISITATIONS AND ATTACKS
Nightmares
Horror
Fighting
Eating
Swimming
Sex in dreams
Oothers
Others
GENERAL LIFE
What problems do you often encounter regularly?
What is your greatest cause of concern in life?
What is your greatest fear in life?
What is your main goal(s) in life?
What are you doing to achieve your goal(s)?
Submit
