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Shop - God Spun Gifts and Creations
Intake Form
The Intake Form is essential in preparing for your session. Your information will be kept confidential and prayed over to invite the Holy Spirit's insight.
Please fill out and submit no later than two days before your session.
History
*
First name
*
Last name
*
Email
*
Phone
Previous Appointments?
Yes
No
I HAVE READ AND AGREE TO THE TERMS OF THE LEGAL RELEASE
Yes
No
Virtual Session Personal Profile
*
Gender
Male
Female
*
Current Age
Occupation
*
Salvation
Yes
No or not sure
*
Marital Status
Married
Divorced
Single
*
Ethnic background from both father and mother sides
*
Describe relationship with biological mother
*
Describe relationship with biological father
*
Were you adopted?
Yes
No
*
Were you conceived out of wedlock?
Yes
No
*
Please list all major physical ailments, diseases or afflictions you have now or have suffered with in the past.
*
Please list any medically diagnosed mental conditions for which you have been treated for and current medications.
*
Please list any and all near death experiences, cycles of accidents, or traumas.
Spiritual Evaluation: Occult Practices
*
Please check all that apply to you.
Astral Projection
Astrology/Horoscopes
Automatic Writing/Painting
Channeling
Fortune Telling
Incantations
Magic: Black, white, green
Ouija Board
Seances
Spells
Tarot Cards
Wichcraft/Wicca
Not Applicable
Spiritual Evaluation: New Age/Psychic Practices
*
Please check off all that apply to you.
Auras
Clairvoyance/precognition
Fire Walking
Levitation
Meditation/Mantras
Mind Control
Parapsychology
Past-Life Therapy
Psychic consultation
Spirit Guides
Telepahy
Trances
Transcendental meditation
Voodoo
Yoga
Not Applicable
Religious Literature
*
Please check all that apply to you.
Bhagavad-Gita (Hinduism)
Book of Mormon
Dianetics (Scientology)
Edgar Cayce
Koran
Necronomicon
Satanic Gigle
Science and Health (Christian Science)
Teachings of Buddha
Not Applicable
Religious Beliefs, Cults, and Secret Societies
*
Please check all that apply to you.
Atheism/Agnosticism
Buddhism/Zen
Church of Satan
Hinduism
Islam
Jehovah's Witness
Kabbalism
Freemasonry
Mormonism
Neo-Nazis/Skinheads
Reincarnation
Santeria
Satanism
Scientology
Voodoo
Witchcraft
Non Applicable
Physical Health Issues
*
Please check all that apply to you.
Cancer
Diabetes
Epilepsy
Gastrointestinal Issues
Heart Disease
Infertility
Miscarriage
Post-Traumatic Stress Disorder
Tumors
Scoliosis
Arthritis
Mute/Deaf/Blind
Other Health Issues
Non Applicable
Mental Health Profile
*
Check all that apply to you.
ADD/ADHD
Anxiety/Panic Disorder
Bipolar
Depression
OCD
Phobias
MPD/DID (multiple personalities)
Schizophrenia
Spectrum Diagnosis
Other
Non Applicable
Emotional/Behavioral Profile
*
Please check all that apply to you.
Panic Attacks
Experience loss of time
Sleep Paralysis
Depression
Fearful
Insecure
Low Self-esteem
Self condemnation
Bitterness
Hatred
Envy
Emotionally Abused
Frustration
Jealousy
Physical Abuser
Physical Abuse Survivor
Abortion
Intent to harm others
Murder
Thoughts of self-harm
Self-harm/cutting
Suicidal thoughts
Suicide attempts
Worthlessness
Rage
Vindictiveness
Unforgiveness
Non Applicable
Dreams
*
Please check all that apply to you.
Nightmares
Being shot at
Being driven somewhere in a car
Bit
Hit/flicked or punched
Being chased
Being bound
Fed food or drink
Eating in general
Preparing food or drink
Animals
Marine entities
Snakes or dragons
Ocean, sea, or lake
Eyes
Emblems
Head covering
Clothing or coat
Shoes
Jewelry
Agreements: paper, or touch
Non Applicable
Criminal Activity
*
Please check all that apply to you
Arrested/imprisoned
Embezzlement
Rape
Selling illegal drugs
Vandalism
Violent acts
Not Applicable
Abberational Behavior
*
Please check all that apply to you
Anxiety Attacks
Anorexia/Bulimia
Compulsiveness
Picking/tics
Shoplifting
Tourette's Syndrome
Non Applicable
Addictions
*
Please check all that apply to you
Alcoholism
Drugs
Food
Gambling
Sex
Tobacco
Prescription drugs
Sleep aids
Shopping
Gaming
Workaholism/overachieving
Numbing out on devices
Non Applicable
Sexual History
*
Please check all that apply to you
Adultery
Fornication/Promiscuity
Molested
Molested someone
Raped
Raped someone
Beastiality
Internet sex
Phone sex
Lustful thoughts
Necrophilia
Perverted sex
Trafficked
Non Applicable
Trauma/Abuse/Accidents/Injuries
*
Events from age 0-5
*
Events from 6-10
*
Events from 11-15
*
Events from 16-20
*
Events from 21 to now
Demonic Activity
*
Please check all that apply to you
Anti-Christ obsessions
Blasphemous thoughts
Curses placed on you by family or someone else
Deny that Jesus is God
Deny the existence of Satan or demons
Desire to curse God/Christ
Hostility toward or rejection of God
Pact with the devil
Sexual actions with a male or female in dreams
Feeling cold air or the room becomes very cold
Vomiting or coughing in response to prayer
Feeling of being choked or unable to breathe
Hearing growling sounds audibly or inside your head
Extreme fear
Hearing your name being called or hearing laughing when no one is around
Fear or mocking of Christian symbols, objects, music, etc...
Alien abduction
Change in voice or facial expressions
Clawing inside or outside your body
Feeling of a snake inside or outside your body
Extreme "off" abnormal thoughts or confusion
Defile Holy objects
Convulsions/seizures
See dark shapes or shadows
See demons
See fairies
See ghosts
See apparitions or people that aren't there
Feel a presence
See monsters
Demonic possession
Eyes turn red when angry
Fear of anointing oil
Fear of holy water
Foaming at the mouth
Inability to speak or move
Extreme mood changes
Near-death experience
Obscene outbursts
Out-of-body experience
Poltergeist activity
Possessed by a living or dead person
Smell strong odors
Sudden sleepiness
Thoughts invaded
UFO sightings
Unable to pray
Unable to read the Bible
Unexplained accidents
Unknown language spoken
Unusual lights
Unusual sounds
Voices of the dead heard
Your name being called or laughing when no one is around
Non Applicable
Misc. information
Anything not listed above.
Submit
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