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Schedule an Exorcism

To schedule an exorcism with us, please fill out the below form. Upon completing this form you will be sent an email with instructions on how to complete your registration and schedule your session. If you do not receive a confirmation email please make sure to check your spam filter and if it is not there then reach out to us here.

Private and Confidential 

This Profile is copyrighted and may not be reproduced in any form without the written permission of Bob Larson and the Spiritual Freedom Church International, Inc. © Bob Larson 2017 

All information supplied in this form is voluntarily given. The respondent has the right to refuse answering any questions and such refusal will not prejudice the interpretation of the information supplied. 

Client Profile Form
Marital Status

Spiritual Information

Salvation/Christian Confession
Describe Your Relationship w/ God?

Family History

Describe your relationship with your parents, stepparents, siblings when you were a child. 

Spiritual Evaluation: Occult Practices

Please check the box of each item you have participated with or in.

Occult Practices

Spiritual Evaluation: New Age/Psychic Practices

Please check the box of each item you have participated with or in.

New Age Practices

Religious Literature

Please check the box of each item you have read, studied, or been in agreement with.

Religious Literature

Religious Beliefs, Cults, & Secret Societies

Please check the box of each item you have participated with or in.

Religious Beliefs

Physical Health Issues

Please check the box of each physical health issue you struggle with.

Physcal Health Issues

Mental Health Profile

Please check the box of each mental health issue you struggle with.

Mental Health Issues

Emotional/Behavioral Profile

Please check the box of each item that applies to you.

Emotional Health Issues
Anger Issues
Abberational Behavior
Criminal Activity
Death Issues
Addictons

Sexual History

Please check any box that applies to you.

Sexual Activity

Trauma/Abuse

List any episodes of abuse, trauma, major accidents, or any other events that deeply affected you

Demonic Activity & Manifestations

Please check the box of each item that applies to you.

Demonic Activity
Demonic Manifestations
Abnormal Demonic Activity
Demonic Manifestations (cont.)
Are You Hearing Any Voices or Having Any Thoughts That:
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