Deliverance Questionaire

Deliverance Ministry Questionnaire (DMQ)

Deliverance Questionnaire.


Part: 1 Doctrine

Do you believe that Jesus is the Christ, and that Jesus is the only begotten Son of God?

A. Jesus is God, my Savior, and yes, I do believe he has come in the flesh, lived, died, and was resurrected, a perfect sacrifice for my sins.
B. I am not sure that Jesus is actually God, maybe a prophet, or something, but not God.
C. I am not sure who exactly Jesus is, but I believe in God.

Saying, The Son of man must be delivered into the hands
of sinful men, and be crucified, and the third day rise again.
Luke 24:27

2. In your walk with Christ, which best describes you?

A. I read my bible regularly, attend church frequently, and have an intimate relationship with God.
B. I do not read my bible regularly, nonetheless I do go to church, and I am not sure exactly where God is in my life.
C. I have asked Jesus in as Savior, but know very little about how to proceed from here.

He that hath my commandments, and keepeth them, he it is
that loveth me: and he that loveth me shall be loved of my Father, and I will
love him, and will manifest myself to him. John 14:21


3. Jesus asked us to be baptized as the first step after becoming a believer, have you been baptized?

A. I have been baptized as and adult, I have completed this step in obedience to Christ.
B. I was baptized as an infant, which is called a dedication there was no remission of
known sin during my baptism.
C. I have never been baptized, but I realize I need to complete this step in my walk with God.
D. I see no need for baptism in my life.


“And were baptized of him
in
Jordan, confessing their sins.” Matthew 3:6
4. What does having faith in God mean to you?

A. I believe not only do I need to read the word of God, but also obey the commands Christ gave to us, my faith being evident by the fruits of my works.
B. I believe I need to read the word of God daily, and trust in what it says.
C. I believe that going to church pretty much describes my obligations to God for my faith.
D. The life I am living now.

5. Are you believing that you can be healed by God?

A. Yes, I believe God can and will heal me today.
B. Yes, I am pretty sure God can heal me.
C. Yes, but I am not sure when God will make up his mind to do so.
D. I am not sure if God will heal me.

6. Do you believe there is more than one way to get to heaven?

A. No, the only way to heaven is through Jesus Christ.
B. Yes, there are a few ways.
C. Being a good person will get me to heaven.

7. Do you believe that the God of the Bible is the same as the God of the Koran?

A. No, they are not the same.
B. No, Allah is not exactly the same thing.
C. Yes,there is only one God over all religions.
D. Yes

8.What is it exactly the man of God can do for you?
A. He can exercise authority over the situation and cast out demons.
B. The prayer of righteous man availeth much.
C. Some ministers can free me while others cannot.
D. Not sure.

Part: 2 The Occult

9. Have you or your ancestors been involved in Freemasonry, or any occult lodges?
(Job's Daughter's,Eastern Star,Shriner's,Knights of Pythias,and any secret societies)
A. No, not that I am aware of to any extent.
B. Yes, It is possible, but I could not say for sure.
C. Yes, my ancestors or I have been involved in Freemasonry

“But what saith the answer
of God unto him? I have reserved to myself seven thousand men, who have not
bowed the knee to the image of Baal.” Romans 11:4


10. Have you or any of your ancestors been involved with Wicca or Witchcraft?

A. No, I have never knowingly practiced witchcraft, nor can I remember any knowledge of my ancestors practicing it.
B. Yes, Some of my ancestors have practiced witchcraft and I myself have participated in seances and played with Ouijas boards.
C. Yes, we have and witchcraft has been in my family.


11. Have you or anyone in your family ever been involved in New Age, Spiritism, or Satanism to any degree?
A. No, there is no involvement to my knowledge in my family to any of these.
B. Yes, there might be some of these things,but I am not fully aware of this being an issue.
C. Yes, either my family or I have been involved in these things.

12. Have you ever played with a Ouijas board?

A No, I have not
B. No, but I have watched it being played by others.
C. Yes, I have.

13. Have you ever used Tarot Cards?

A No, I have not
B. No, but I have watched
C. Yes, I have.

14. Have you ever done palm reading?

A. No, I have not
B. No, but I have watched
C. Yes, I have.

15. Have you ever done tea leaf reading?
A No, I have not.
B. No, but I have watched.
C. Yes, I have.

16. Have you ever participated in a Seance's?
A. No, I have not
B. No, but I have watched
C. Yes, I have.

17. Have you ever consulted a Psychic?
A No, I have not
B. No, but I have watched
C. Yes, I have.

18. Have you been involved in any other religions?

A No, I have not
B. No, but I have participated in a ceremony once.
C. Yes, I have.

19. Have you ever made any pact with the devil?
A No, I have not
B. No, but I may have said something I shouldn’t have.
C. Yes, I have.
“And he caused his children to pass through the fire in the
valley of the son of Hinnom: also he observed times, and used enchantments, and
used witchcraft, and dealt with a familiar spirit, and with wizards: he wrought
much evil in the sight of the LORD, to provoke him to anger.” 2nd Chronicles
33:6

Part: 3. Dis-Associative Identity Dis-Order

20. Have you ever been diagnosed with DID-Dis-associative Identity Disorder, or MPD-Multiple Personality Disorder?
A. No, I never have, and I do not believe I have multiple personality.
B. No, I never have, but I do have parts of my life I cannot recall,and also
I lose time frequently.
C. Yes, I have been diagnosed with DID, or MPD and believe it is present within my life?

21. Do you have any areas in your life where you have lost track of time?
A No, I do not
B. No, but occasionally I miss brief moments
C. Yes, I have

22. Do your emotions frequently seem to be up and down?
A No, they are steady
B. Occasionally, I have an outburst
C. Yes, my emotions are all over the place.

23. Have you ever been the victim of extreme trauma?
A. No, I have never suffered any extreme trauma.
B. Yes, I have been the victim of an accident or injury trauma
C. Yes, I was badly beaten or abused as a child or young adult.
D. Yes

24. Were you ever the victim of child abuse?
A. No, I was never abused as a child
B. No, I was disciplined but never abused.
C. Yes, I was abused.
D. Yes

Part: 4 Addictions

25. Do you currently take any longstanding medications?
A. No, I do not take any regular medications.
B. No, but I occasionally take over the counter stuff.
C. Yes, I take over the counter meds as well as prescription meds.

26. Do you take any illegal substances?
A. No, I never take any drugs that are illegal.
B. No, but I have in times past.
C. Yes, occasionally I do take illegal drugs

27. Do you currently Smoke, Drink Alcohol, or have any addictions?
A. No, I do not smoke or drink, nor do I have any addictions.
B. No, I do not smoke or drink, but I do have an addiction.
C. Yes, I smoke or drink and I have addictions to other things
D. Yes, I smoke or drink, but I have no other addictions to other things.

28. Do you struggle with Pornography?
A. No, never had this problem
B. Occasionally have done this.
C. Yes, frequently I struggle with pornography.

29. Do you have any problems with masturbation?
A. No
B. Occasionally
C. Yes

Part: 5 Forgiveness

30. Did your Mother ever say she loved you?
A. Yes, she did say she loved me.
B. Yes, but it was not very often.
C. No, she never really said she loved me openly.
D. Never knew her as a child

31. Do you forgive your mother for anything she has ever done to you?
A. Yes, I forgive her of everything she has ever done to me.’
B. Yes, but I cannot forget what she has done to me.
C. No, I cannot forgive her of what she did to me.

32. Did your father ever say he loved you?
A. Yes, he did say he loved me.
B. Yes, but it was not very often.
C. No, he never really said he loved me openly.
D. Never knew him as a child

33. Do you forgive your father for anything he has ever done to you?
A. Yes, I forgive him of everything he has ever done to me.’
B. Yes, but I cannot forget what he has done to me.
C. No, I cannot forgive him of what he did to me.

34. Do you have any brothers and sisters and how is your relationship with
them?
A. I love them and have forgiven them all for anything that has happened.
B. I have forgiven them but I have not forgotten all that was done.
C. I have not forgiven them.

35. Is there anyone else in your life you cannot forgive?
A. No, I forgive everyone.
B. Yes, there is someone I cannot forgive.
C. I cannot forgive myself


Part 6. Family, and Relationships.

36. Are you married to a believer?
A. Yes, my spouse is a believer.
B. Yes, my spouse claims to believe in God, but does not go to church.
C. No, my spouse is not a believer.
D. I am not sure if my spouse is a believer.

37. Are you in a relationship outside of marriage?
A. No, I am not currently in a relationship.
B. Yes, but I am engaged to be married.
C. Yes, but we are not sexually active.
D. Yes, I am in a relationship outside of marriage and we are active sexually.
38. Have you ever been physically violated by anyone sexually?
A. No, I have not.
B. Yes, when I was a child.
C. Yes, I have.

39. Do you let your partner control you either physically or emotionally?
A. No, I do not
B. No, but it has happened in the past.
C. Yes, it does happen but not often.
D. Yes

40. Do you believe you can get free if your spouse is not free?
A. No,I know my spouse has to be free as for me to experience complete freedom?
B. No, I know I can become free, but there may be some issues that remain that are less significant.
C. No.
D. Yes

41. Is your freedom worth giving up being around family members if they seek only to oppress you?
A. Yes, I would leave or not return to those who abuse me.
B. No, I cannot leave the situation I am living in now.
42. Are you in a relationship with someone, and not married to them?
A. Yes
B. No.
43. Is there anything in your life, or relationship, in which you feel God is displeased?
A. Yes.
B. No.
Part 7: Health, and Wellness:
44. What would you say below is the best way to describe your emotions daily?
(Highlight or circle the applicable issues.)
A. Fear,Shame,Anxiety.
B. Depression,Rejection,Suicide
C. Anger,Hatred,Rage,Murder.
D. Resentment,Bitterness,Unforgiveness,
E. Bitterness,Rejection,Rebellion,Mental Illness
F. Confusion,Forgetfulness,Dementia,Mind Control-Block
G. Pain,Sickness,Infirmity,
H. Blindness,Loss of Hearing, Loss of Speech,Insanity
I. Poverty,Greed, Guilt.
J. Envy,Covetousness,Jealousy
K. Pride,Arrogance,Criticism,Perfectionism
45. In which part of your body do you experience the most difficulty?
A. Head,Neck and Shoulders
B. Heart,Blood Pressure,and Stroke
C. Hands,Feet and Mouth
D. Back,Lower Back and Spine
E. Skin,Liver,and Kidneys
F. Reproductive Areas
G. Lungs,Breast,and Breathing
H. Bowels,Intestines,and Stomach
I. Eyes,Ears,and the Brain
46. Are any of the following things common with you?
A. Vertigo
B. Headaches
C. Body Pain
D. Asthma
E. Skin Irritations
F. Flu's and Sickness
G. Bloating and Diarrhea
H. Dizzyness
I. Heavyness
47. Do you believe if God heals people today from physical infirmities?
A.Yes
B.No
Part 8: A relationship with God.
48. What kind of relationship do you feel best describes you and God?
A. I love him and God loves me.
B. I love him and yet, I am not sure if God loves me.
C. God loves me,but I have been backslidden.
D. I feel as if I have made God upset with me through disobedience.
E. I do everything I can just to please him,but I am not sure if he is pleased.

49. Would you say that you are reading the word of God, and your prayer in your life was adequate?
A. Yes,I pray and read the word often.
B. Yes,I pray but I don't read God's word as much as I believe God wants.
C. Yes, I read the word,but I am unsure as to how to pray to God.
D. No, I am falling behind in those areas.
50. How would you describe fellowship with others in your life?
A. I go to church and fellowship regularly.
B. I fellowship with other believers on occasion.
C. I do not fellowship with other believers that often.
D. No I don't join into fellowship with other believers.
51. My impression of God is closest to which of the following?
A. I sin on occasion,and I am forgiven as long as I repent for it.
B. I do sin on occasion but immedietly feel the need to repent.
C. I am a good person so I believe my sins are not all that pressing.
D. I know God says not to sin, but I struggle with the same sin regularly.
E. I have no sin.
52. What is your knowledge of curses, and blessings when it comes to God?
A. I can sin and God will not bless it,but there is no curse for the sin I have commited.
B. God will bless me if my life and His word are in harmony,but other than that sin can bring a curse.
C. I have no curse, I have been freed from that,so there is nothing that I struggle with that
was possibly because of an ancestoror a curse on me.
D. God can curse and he can bless and with the good comes blessings and with sin comes a curse.
E. I repent so I have nothing on my slate to be forgiven for at the moment.
53. What best describes God's position over your life as you would see it?
A. A loving Father
B. A distant taskmaster.
C. A merciful God.
D. A God of justice,and judgement.
E. A God of love and justice.
F. A best friend.
G. God is unfair
54. If God created you for a purpose, what would best describe it?
A. I am a perfectionist,but have found myself struggling to do my best in business
and in life.
B. God created me to be a disciple, and to live for him therefore his will not my will be done.
C. I am not sure why God placed me here.
D. I want to live my life in peace, and do those things with which I feel God is pleased.
E. Not sure.
Part 9: Demons and Deliverance
55. Have you ever had any prior deliverance?
A.Yes
B. No
56. Have demons ever manifested using your mouth?
A.Yes
B.No
57. Have you ever identified your demons?
A. Yes
B. No
58. Do you struggle with prayer,and or praise and worship?
A.Yes
B. No.
59. Do you struggle with reading God's word?
A.Yes
B. No
60. Did you have anything in particular that you feel brought the demonic into your life?
A. Yes
B. No.
61. How do you feel about deliverance?
A. I am ready to do whatever I have to ,just to get free.
B. Whatever God gives me I will be happy to receive.
C. I'm just going through this because another person wants it for me.
D. I don't think I can get free.
62. Do you see spiritually dark things in your home or office?
A. Yes
B. No
63. Have you performed a spiritual house cleaning?
A.Yes
B. No
64. If you had a wonderful Egyptian vase or keepsake that opened the door for
the demonic would you be inclined to break and remove it if asked?
A. Yes
B. No

65. Do you have nightmares frequently?
A.Yes
B. No.
66. Are you ever assualted physically while awake, or while you sleep by an unseen force?
A.Yes
B. No.
67. Have you or anyone in your family been dedicated to Satan, or any false God through a ceremony or by any religious group, or society?
A. Yes
B. No.
68. Have you or anyone in your household that you know of signed any agreement or pact
that comes to mind that could be displeasing to God?
A.Yes
B. No.
69. Have you ever sworn an oath to anyone, or anything other than God?
A. Yes
B. No.
70. Have you or anyone in your family been in a coma?
A. Yes
B. No.
71. Who are you in Christ Jesus?
A. I am not sure.
B. I am a child of God.
C. I know who I am in Christ,and I am persuaded that God is able to keep me.
72. Have you any experience putting on the whole armor of God according to Ephesians 6?
A. Yes.
B. No.
73. Are same sex relationships an issue for you?
A. Yes
B. No
74. Are your children experiencing any of the same things you are?
A. Yes
B. No

75. RELEASE/WAIVER
Deliverance Waiver and Release

Tammy Wennerstrom Deliverance Minister
5977 Flaig Dr Fairfield, Oh 45014
513-226-0756
WAIVER AND RELEASE OF LIABILITYPART A – PARTICIPANT WAIVER – RELEASE FROM LIABILITY I HEREBY AGREE TO INDEMNIFY, SAVE AND HOLD HARMLESS ,
Tammy Wennerstrom ,and/or itsdesignated representatives, from any loss, liability, damage or cost that may incur due to thepresence of the undersigned in any location of attempted ministry,church,home, building or office , or in any wayduring ministry,counseling, or observing or working for or for any purpose participating in the activity of deliverance ministry. EACH OF THE UNDERSIGNED expressly acknowledges and agrees that the activities associated with crisis counseling and deliverance ministry are inherently dangerous at times, and involve the risk of serious injury and/or death and/or property damage. Each of the undersigned further expressly agrees that the foregoing release and waiver agreement is intended to be as broad and inclusive as is permitted by the laws of the state in question.................................. if non specified then considering Arizona, and that if any portion thereof is held invalid, it is agreed that the balance shall, not withstanding, continue in full legal force and effect. THE UNDERSIGNED HAS READ AND VOLUNTARY SIGNS THE RELEASE AND WAIVER OFLIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representation, statements or inducement apart from the foregoing written agreement have been made. This waiver release and indemnification agreement specifically embraces each and every activity sanctioned or promoted by said release during the entire duration of the activities and applies to each and every event, or activity herein mentioned and has the same effect as executed after each and every activity or event in which the undersigned participates so that the parties herein intended to be released and indemnified shall be fully and effectively released and indemnified as to each and every activity herein described. SIGNED:________________________________________ DATE:___________WITNESS:_______________________________________ DATE:___________ADDRESS:__________________________________ STATE:___ ZIP:________PHONE: _____________________________PART B – PARTICIPANT WAIVER –RELEASE OF ALL VIDEO,AUDIO OR DOCUMENTS REGARDING MINISTRY In regards to all documents, video or audio recordings of each session made with the undersigned! I HEREBY RELEASE : Tammy Wennerstrom Ministries of Fairfield Oh, and/or its designated representatives, from any liability and all damages in the event of or release of any said film, audio or document pertaining to my deliverance session, Tammy Wennerstrom Ministries. of Fairfield Oh, will upon my signing be the power of attorney over any film, audio or documentary I have allowed to be present at the time of my ministry session, they will be responsible to disclose this to me verbally and in written form if I so desire, this disclosure. I am of sound mind and make this decision without any outside influence. By signing below I agree to this release of any video, or audio footage or documentation of my ministry experience .SIGNED:________________________________________ DATE:___________WITNESS:_______________________________________ DATE:___________ADDRESS:__________________________________ STATE:___ ZIP:________ PART C – PARENTAL WAIVER – RELEASE FROM LIABILITY(If the applicant is under 18 years of age, the parent(s) or guardian(s) must execute in addition to the above, the following waiver.)The undersigned ___________________ referred to is the parent and natural guardian or legal guardian of ___________________ does hereby represent that he/she is in fact acting in such capacity and agree to save and hold harmless and indemnify the Tammy Wennerstrom Ministries of ,and/or its designated representatives from all liabilities, loss, cost, claim, or damage whatsoever, may be imposed upon said release because of any defect in or lack of such capacity to so act and release on behalf of both the undersigned. NAME:________________________________ RELATIONSHIP TO MINOR:_________NAME:________________________________ RELATIONSHIP TO MINOR:_________
This document is confidential and is the sole property of Tammy Wennerstrom Ministries of 5977 Flaig Dr Fairfield Oh. 45014 513-226-0756 copyright @all rights reserved 2009








Ordained Minister/Pastor.....................................................................
NOTES OF INTEREST