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Freedom Session Form
Sozo is a Greek word meaning wholeness. wholeness in spirit. Wholeness in soul (mind, will, and emotions) • wholeness in body.
Our Sozo ministers specialize in helping you reconnect with the heart of God to experience breakthrough, inner healing, and deliverance from demonization. Each session is unique to you because it’s led by the Holy Spirit.
First Name
Last Name
Email
General Information
Phone Number
Address
Apartment, suite, etc.
City
State
Zip/Postal Code
Best Time to Meet
Week Days
Week Nights
Weekends
Other
Gender
Male
Female
Birthdate
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Marital Status
Single
Married
Widowed
Separated
Divorced
Prior Marriages
Yes
No
Names of Children
Were you the first born?
Yes
No
Are you a Born-Again Christian?
Yes
No
What church do you currently attend and how long have you been attending?
Confidentiality Policy
I consent to sharing this with Beach Assembly Pastoral Staff.
Please check the box if you consent to sharing all information shared in form with Beach Assembly Pastoral Staff. This form will be utilized in your Sozo Session, and all information shared in the session and on this form is completely confidential and will be shared with no one.
Upon completion of your session, we will delete this form.
Specific Questions
The purpose of this form is to help determine possible entryways for evil spirits. Obviously, generational/ancestral permission as forewarned in Exodus 20:5 is a possibility in anyone's life. There are 30 ancestors in your history that could have passed a spirit on to you. Likely you only know about your parents and each of their two parents.
Please give any information that the Holy Spirit brings to your mind. Examples would be involvement with the occult, sexual perversion, alcoholism, depression or mental disorders, lots of divorce, adultery, anger, criminal activity, births out of wedlock, or involvement in groups such as Masonry, Eastern Star, Rainbow Girls, Oddfellows and Rebecca Lodge, etc.
It is not necessary to go into great detail with any of your responses. Ask the Holy spirit to show you any area of concern.
Are you aware of any ancestry involvement in any of these?
Yes
No
From birth and your early childhood: Are you aware of any trauma you might have experienced during your mother's pregnancy? Accidents, divorce, spoken words such as "We shouldn't be having a child", etc.?Text Area
Do you recall any early childhood fears, injuries, nightmares? Do you remember seeing things in your room or feeling an evil presence? Do you recall any encounters of a supernatural kind?
Any sexual abuse or sexual embarrassment through childhood?
Do you recall any spoken words from parents, or others that were condemnation? Embarrassing or humiliating experiences at school or from a school teacher? Examples: "You're fat; You're stupid; You'll never amount to anything; You always mess up; I don't know why we had you; You can't be in our group"; etc.
Any physical abuse from parents or others?
Involvement (however innocently it may have been) with Ouija boards, Magic 8 Ball, levitation games, seances, fortune tellers, tarot cards, astrology, horoscopes, fascination with books about magic, psychics, seers, Harry Potter books, Pokemon Cards, etc.?
Please list any accidents or injuries that come to your mind as being frightening to you at the time:
Please list surgeries and approximate age:
Movies or TV programs that were particularly frightening to you, or specific scenes that seem to stick to your memory:
Have you participated in pre-marital sex?
Yes
No
Periods of habitual immorality? (including pornography, sexual fantasy, promiscuity, etc.)
Drinking and/or Drug use?
Do you experience unusual fears?
What do you think may be areas of demonic influence in your life?
Are (or were) there any significant problems in the home?
Are your parents divorced?
Yes
No
Unusual feelings such as: Never really felt loved, couldn't please my father/mother, feelings of worthlessness. etc.?
Have you been exposed to Pornography?
Yes
No
Please answer the following questions as they apply to your life:
Homosexual tendencies?
Yes
No
Participated in college fraternities or sororities?
Yes
No
Feelings of Guilt and Shame?
Yes
No
Hopelessness?
Yes
No
Fatigue without medical reason?
Yes
No
Have you had or funded an abortion?
Yes
No
Difficulty in forgiving?
Yes
No
Do you experience feelings of self-hate?
Yes
No
Have you suffered from self-harm?
Yes
No
Do you have feelings of Gloom?
Yes
No
Do you feel Rejected?
Yes
No
Do you have any objects in your home or possession that relate to ungodliness or cults? This would include: New age religions, such as books about eastern deities, crystals, heavy metal music, Native American/African artifacts, Items connected with other religions or rituals, Wiccan or other occult items, etc.?
Yes
No
Have you ever "felt" a presence in the room?
Yes
No
Do you have nightmares?
Yes
No
Do you hear voices?
Yes
No
Have you been diagnosed by a doctor as having: (list any diagnosis, diabetes, asthma, hypertension, etc.)
Yes
No
Do you have any inexplicable pain, with no medical reason for it?
Yes
No
Do you have difficulty trusting others?
Yes
No
Has there been a death of someone close to you?
Yes
No
Do you feel like you have any eating disorders?
Yes
No
Do you suffer from sleep disorder?
Yes
No
Any other medically defined disorder?
Yes
No
Is there a history in your family of tuberculosis, diabetes, ulcers, cancer, heart disease, glandular problems, asthma, etc.?
Yes
No
Did you have imaginary friends as a child?
Yes
No
When attending church or other ministries do you have "foul" thoughts, jealousies or other mental harassments?
Yes
No
Do you have difficulty retaining God's word?
Yes
No
Difficulty reading God's word?
Yes
No
Do you have consistent migraine headaches?
Yes
No
Do you have any addictions?
Yes
No
Were you ever diagnosed with a learning disability? (I.e. A.D.D. etc.)
Yes
No
Do you have a fear of death?
Yes
No
Have you ever had suicidal thoughts?
Yes
No
Has there been a period of time in your life when you were angry with God?
Yes
No
Do you have a fear of losing your mind?
Yes
No
Do you suffer from anxiety or panic attacks?
Yes
No
Do you feel incredible loneliness?
Yes
No
Are you plagued with doubt and unbelief?
Yes
No
Do you feel inferior?
Yes
No
Do you have thoughts of inadequacy?
Yes
No
Do you have obsessive thoughts?
Yes
No
Blasphemous thoughts?
Yes
No
Compulsive thoughts?
Yes
No
Lustful thoughts?
Yes
No
Do you daydream?
Yes
No
Are you a perfectionist?
Yes
No
Are things seemingly always out of order?
Yes
No
Do you feel the need to be in control?
Yes
No
Are you rebellious?
Yes
No
Feelings of insecurity? (On a scale of 1-10 with 10 being the worst)
1
2
3
4
5
6
7
8
9
10
Below are a few symptoms of demonic attack.
Please check all that apply to you:
A compulsive desire to blaspheme God
A revulsion against the Bible, including a desire to tear it up or destroy it
Deep feelings of bitterness and hatred toward others without reason Examples: Jews, other races, the church, strong Christian leaders, etc.
Any compulsive temptations, which seek to force you to thoughts or behavior which you truly do not want to do or think
Compulsive desires to tear other people down, even if it means lying to do so. Vicious cutting down of others by the tongue
Terrifying feelings of guilt even after honest confession is made to the Lord
Certain physical symptoms which may appear suddenly or leave quickly and there are no physical or physiological reason
Choking sensations
Pains that seem to move around and for which there is no medical cause.
Feelings of tightness about the head or eyes
Dizziness, blackouts, or fainting seizures
Deep Depression or despondency
Sudden surges of violent rage, uncontrollable anger, or seething feelings of hostility
Terrifying doubt of ones salvation even though they once knew the joy of salvation
Seizures of panic or other fear that is terrifying
Dreams or nightmares that are of a horrific nature and often recurring. Clairvoyant dreams that may even come true are most often demonic
Abnormal or perverted sexual desires
Questions and challenges to God's word
Sleep or eating disorders without physical cause
Most compulsions or obsessions
Rebellion and hatred for authority
Bizarre, terrifying thoughts that seem to come from nowhere and you cannot control them
Fascination with the occult
Involvement in criminal activity
Extremely low self-image (unworthy, a failure, no good - a constant undermining of the identity)
Constant confusion in thinking (Sometimes great difficulty in remembering things)
Inability to believe (even when the person wants to)
Mocking and blasphemous thoughts against preaching/teaching of the word of God
Perpetual distortions - perceiving anger, hostility, in others when it doesn't really exist- seeing only judgement in the scriptures
Horrible nightmares causing fear (often having demonic images)
Violent thoughts (Suicidal, homicidal encouraging self abuse, etc.)
Hatred and bitterness toward others for no justifiable reason
Tremendous hostility or fear when encountering someone involved in deliverance work
Feelings of being watched or sensing an evil presence
Irrational fears - Panic attacks - phobias
Irrational anger - rage
Irrational guilt - self-condemnation to the extreme
Desire to do what is right (inability to carry it out)
Sudden personality and attitude changes (Severe contrasts - appears schizophrenic, Bi-polar disorder)
A strong aversion towards scripture reading and prayer (especially one on one)
A dark countenance (steely or hollow look in eyes - contraction of the pupils - sometimes facial features contort or change - often an inability to look at others in the eyes)
Lying, exaggerating or stealing compulsively (often wondering why)
Drug abuse (especially when there is demonic hallucinations)
Eating obsessions - bulimia, anorexia, nervosa
Compulsive sexual sins (especially perversions)
Irrational laughter or crying
Irrational violence - compulsion to hurt self and/or others.
Sudden speaking of a language not previously known (often an ethnic language of ancestors)
Reactions to name and blood of Jesus Christ (Verbally or through body language)
Extreme restlessness (especially in a spiritual environment)
Uncontrollable cutting and mocking tongue
Vulgar language and actions
Loss of time (from minutes to hours - ending up somplace, not knowing how you got there- regularly doing things of which there is no memory)
Extreme sleepiness around spiritual things
Demonstration of extraordinary abilities (either ESP or Telekinesis)
Voices are heard in the mind (they mock, intimidate, accuse, threaten, or bargain)
Voices refer to him/her in third person
Supernatural experiences - hauntings, movement or disappearance of objects, and other strange manifestations)
Seizures (too long and/or too regular)
Pain (without justifiable explanation - especially in head and/or stomach)
Blackouts
Physical ailments can often be alleviated immediately by a command of spiritual authority (I.e. epileptic seizure, asthma attacks, various pains)
Sudden interference with bodily functions (temporary) - buzzing in ears, inability to speak or hear, sudden severe headache, hypersensitivity in hearing or touch, sudden chills or overwhelming heat in body, numbness in arms or legs, temporary paralysis
Any Additional Comments/Questions/Concerns can be listed below:
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