Personal Spiritual Profile - It Ain't Over Ministries

Personal Spiritual Profile Form

Newsletter

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First Name

Middle Name

Last Name

Age

Date of Birth

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

1. Describe your relationship with your parents, step-parents, siblings, when you were a child.

Biological Father

Good

Bad

Indifferent

Biological Mother

Good

Bad

Indifferent

Step Father

Good

Bad

Indifferent

Step Mother

Good

Bad

Indifferent

Siblings

Good

Bad

Indifferent

2. Were you a wanted/planned child?

Yes

Don't Know

3. Were you the sex (gender) your parents wanted?

Yes

Don't Know

4. Were you conceived out of wedlock?

Yes

Don't Know

5. Were you adopted?

Yes

Don't Know

6. Did your mother suffer any trauma during her pregnancy?

Yes

Don't Know

7. Are your parents living?

	Biological Father	Biological Mother	Adopted/Step Father	Adopted/Step Mother
Yes
No
Don't Know

8. Are your parents: (Check all that apply)

Married

Divorced

Father Remarried

Mother Remarried

9. Was Your Father...

Passive

Strong

Indifferent

Absent

10. Was Your Mother...

Passive

Strong

Indifferent

Absent

11. Did you have a happy childhood?

Yes

Somewhat

12. Do you have trouble giving or receiving love?

Yes

Somewhat

13. Were you kept in Foster Care?

Yes

14. Were you rejected by parents/peers?

Yes

If you answered "Yes" above, please explain.

15. Were you rejected by spouse/lover?

Yes

If you answered "Yes" above, please explain.

16. Were you cursed by parents/peers?

Yes

Not Sure

If you answered "Yes" above, please explain.

17. Have you participated, at any time in your life, in any of the following Occult Practices? Check all that apply.

If you answered "Other" above, please explain.

18. Have you participated, at any time in your life, in any of the following New Age/Psychic Practices? Check all that apply.

If you answered "Other" above, please explain.

19. Have you ever read, at any time in your life, any of the following Religious Literature? Check all that apply.

If you answered "Other" above, please explain.

20. Have you ever participated, at any time in your life, in any of the following Religious Beliefs, Cults, & Secret Societies? Check all that apply.

If you answered "Other" above, please explain.

21. Do you currently, or have you ever had any of the following Physical Health Issues?

If you checked any of the boxes above, please list each one on a separate line and give more details.

22. Do you or a family member currently have, or have ever had any of the following Mental Health Issues? Check all that apply.

If you checked any of the boxes above, please list each one on a separate line and give more details.

23. List ALL medications you are currently taking. (Note - If you are not currently on any prescription medication, just type "N/A" in the box)

24. Have you recently, or ever received a Psychiatric or Psychological Diagnosis?

Yes

If you answered "Yes" above, please explain in detail.

25. Have you ever seen a Psychologist?

Yes

If you answered "Yes" above, please explain in detail.

26. Have you ever seen a Psychiatrist?

Yes

If you answered "Yes" above, please explain in detail.

27. Have you ever received "Electrical Shock Treatment"?

Yes

If you answered "Yes" above, please explain in detail.

28. Do you ever have feelings of guilt?

Yes

If you answered "Yes" above, please explain in detail.

29. Do you have terrifying seizures of panic or other abnormal fears?

Yes

If you answered "Yes" above, please explain in detail.

30. Have you ever acted like a child since becoming an adult?

Yes

If you answered "Yes" above, please explain in detail.

31. Do you experience loss of time and sometimes don't remember what happened?

Yes

If you answered "Yes" above, please explain in detail.

32. Have you experienced night paralysis?

Yes

If you answered "Yes" above, please explain in detail.

33. Are portions of your life missing from memory?

Yes

If you answered "Yes" above, please explain in detail.

34. Do you currently, or have you ever had any of the following? (Check all that apply)

If you checked any of the boxes above, please list each on a separate line and explain in detail.

35. Do you have any of the following Anger Issues?

If you checked any of the boxes above, please list each on a separate line and explain in detail.

36. Do you have any of the following Death Issues?

If you checked any of the boxes above, please list each on a separate line and explain in detail.

37. Do you have any of the following Abberational Behaviors?

If you checked any of the boxes above, please list each on a separate line and explain in detail.

38. Do you have any of the following Addictions?

If you checked any of the boxes above, please list each on a separate line and explain in detail.

39. Have you ever had an issue with, or personally been convicted of any of the following Criminal Activity?

If you checked any of the boxes above, please list each on a separate line and explain in detail.

40. Check ALL that applies ot your personal Sexual History.

If you checked any of the boxes above, please list each on a separate line and explain in detail.

41. List any episodes of Abuse, Trauma, Major Accidents, or any other events that deeply affected you. (Give details in appropriate "age" spaces below)

Events from age 0 to 5

Events from age 5 to 10

Events from age 10 to 15

Events after 20

42. Have you ever participated in any of the following Demonic Activity?

If you checked any of the boxes above, please list each on a separate line and explain in detail.

43. Have you ever experienced any of the following Demonic Manifestations?

If you checked any of the boxes above, please list each on a separate line and explain in detail.

44. Have you ever experienced any of the following Abnormal Demonic Activity?

If you checked any of the boxes above, please list each on a separate line and explain in detail.

45. Have you ever heard voices or had thoughts that:

If you checked any of the boxes above, please list each on a separate line and explain in detail.

46. Is there anything else that filling out this profile has brought to your mind, or anything related to an issue above that you feel is significant to your spiritual goals and welfare?

47. After reviewing all the above, what have you learned about yourself that you did not realize before filling out this profile?

48. Were there any surprises or unexpected issues in your life that you had not previously recognized, and that you now see as critical to your spiritual progress?

49. After answering these questions, in what way do you understand your spiritual condition better?

50. After completing this profile, what would you say is the most serious area of your life that needs spiritual improvement?

51. Based on the above, what areas of concern would you first like to address?