Personal Information

Age: (         ), Marriage Status: Married(     ) Single(      ),

Gender: Male (        ) Female(         )

Position in the Church

Atheist (         ), Church Member(          ), Deacon(           ), Elder(           ),

 Catechist(         ), Pastor’s wife(         ), Pastor(           )

Belief History

None(            ), Born as Christian(          generation), First Generation (         years)

Attending Church

(                              ) Church

Reason for requesting deliverance;

Sickness (Physical)

Spritual Difficulties : 

Any other reason : 

Requesting Date and Day

 Requesting date :

For Southern California HODAH, we will held deliverance ministry on every Thursday.  For special occasion we can arrange other day.

* After requesting deliverance ministry,

please check your deliverance date.