Comfort My People Ministries

Email:

Full Legal Name: ______Date ______

Address: ______(City/ST/Zip) Phone: ______

Email: ______Birthday ______Single Married Divorced

What is your occupation? ______

Salvation Experience (Explain)______

______

How did it change your life? ______

______

Are you plagued with doubt about your salvation? ______

Do you have problems praying and reading the bible daily? ______

“Brief” events and trauma that impacted you and your life the most in a negative way: Parents, siblings, ancestry, early and near deaths, infirmities, rejection, accidents, mental illness (incarcerations), memory loss, sexual issues, etc. Please begin at the youngest age you can remember.

AGE: ___3__ Event: Example: Fell from bridge, rejected by mother, grandfather died______

AGE: ______Event: ______

Comments: ______

______

Transgression(s) (willful sin you are currently involved in; i.e. living with someone out of wedlock): ______

Un-forgiveness: (list people, events, etc.) ______

______

Current Medication/Prescriptions: ______

Mental / emotional issues

Repeated chronic sickness (especially hereditary)

Bareness, miscarriage, female problems (applies to all

females in the family)

Family alienation, break down of marriage, failed

relationships, friends, associates

Continuing financial insufficiency

Being “Accident Prone”

History of suicides and unnatural/untimely deaths

Curses: Inner vows & judgments against:

God (anger, vows, promises, etc.) Parents Yourself Spouse Children Others

Curses by others towards you: (Ask the Holy Spirit to reveal them to you)

Parents Spouse Employers/Co-workers Physicians Others ______

Word Curses Spoken by YOU:

About Yourself (Self-image) Spouse Children Family Towards Others

Verbal Abuse: Explain: Family______

Others (Explain) ______

Physical Abuse: Explain: Family______

Others (Explain) ______

Sexual Abuse: Explain: Family______

Others (Explain) ______

Emotional Abuse: Explain: Family______

Others (Explain) ______

Mental Abuse: Explain: Family______

Others (Explain) ______

Self-Inflicted Abuse: Verbal Physical Mutilations (cutting, piercing, hair pulling) Sexual

Emotional Mental Eating disorders Tattoos Attempted Suicide Other

EXPLAIN: ______

______

Conception: 1st Born Planned Conceived in wedlock

Rape / Incest Prostitution Other ______

In the Womb: Happy Secure Loved

Trauma Fear Near Death Experience

Delivery / Easy Cesarean Did you want to be born?

Birthing Hard Other ______Was your birth premature,

______complicated, traumatic, etc.?

Comments: ______

Good Average Bad Lonely Fearful Unharmonious Harmonious Rejected Unloved Loved

Raise Yourself Raise Others Few Friends Many Friends

Stable home life Nightmares Dreams Imaginary playmate

Trouble Sleeping _____Age Do you still have sleeping problems

Comment:______

Are you adopted? EXPLAIN: ______

Were any of your children conceived out of wedlock? EXPLAIN:______

Have lapses of memory or blocks of time missing? EXPLAIN: ______

Do you fantasize and/or daydream? EXPLAIN: ______

Do you have compulsive thoughts or obsessive behaviors? EXPLAIN: ______

I have experienced fear that is strong and prolonged?

I have experienced depression that is strong and prolonged?

Do you struggle with: Extreme Unforgivness Hatred Bitterness Withdrawal/Loneliness

Manipulation Co-dependency Sorrow Selfishness Stubbornness

Perfectionism Hardness of Emotions Strong self-will

Personal emotional experiences: Foster Homes Boarding Schools Homeless Hunger

Eating Disorder Military Family Oppression Abandonment Institutionalized

Murdered or Attempted to Preacher Family Shock treatment Hospitalized Other

Did your behavior require: Psychiatrist Physiologists Counseling Medications for School

Attempted suicide? Number of times _____ EXPLAIN: ______

Have you heard voices/emotional/obscenity/sexual messages in your mind?

Have you had personal conversations with spirit realm?

Do you feel confusion and/or “trafficking” in your mind?

Do you feel anxious most of the time (restless, a whirlwind)? EXPLAIN:______

Have you had physical and/or spiritual experiences with heaviness, including sexual dreams, etc.

Describe: ______

Do you wear/have in your possession symbols, charms (lucky), statues, masks, dream catchers, or

items that may have been used in worship of any false god, mystic or used in a spiritual experience?

Have you encouraged and/or been involved sexually or emotionally with anyone that had an abortion?

Father living Mother living Biological parents still married

Divorces in the family Have YOU experienced divorce? Number of times ______

Raised in a Christian environment Head of the household was: Father Mother Other

Was there manipulation? Who______Is there co-dependency in the family?

What was your family financial situation: Poor Average Good

Family addictions: Alcohol Drugs Tobacco Sweets Other ______

Family emotional traits: Anger Bitterness Unforgivness Fear Depression

Mental Illness Lust Broken family relationships

Intellectual Pride Other ______

How were you raised? Permissive Average Strict No one cared

Excessive behavior problem: Workaholic Sports Computers Materialism

(Modern Idolatry) Entertainment Hobbies TV/Radio Other ______

Has any family member been in prison for extended time? Reason:______

YES NO If you mark, YES please describe, explain, or comment.

Did you receive physical and emotional support growing up? Father Mother Other

Did either parent show tender emotions toward you growing up? Father Mother

One or both parents show favoritism to others?

DESCRIBE:______

Did you parents believe and support you emotionally when you needed help?

COMMENT: ______

Did parents cause division among the children? EXPLAIN: ______

Was either parent a perfectionist? Father Mother

Did you have someone that prayed for you? Who? ______

Was your self-worth (self-esteem) based on performance or approval?

EXPLAIN: ______

Has any family member personally approved of, been involved with, and/or murdered someone.

Has anyone in your family associated with and/or participated with gangs, mafia, trafficking

humans, drugs, kidnapping, etc.?

To the best of your knowledge have you, your family, your ancestors (male and female sides) experienced, been involved with, or committed any of the following : Rape Incest Abortions

Sexual perversion Sacrifices (human or animal) KKK Zen American Indians

Dedications by parents or authorities over you to false religions or occults Illuminati

Demonic Games Demonic shows/books (Harry Potter) Demonic music/ Performers

Secret Organizations Other ______

P.O. Box 14126 Arlington, TX 76013 817-642-9772 Personal Ministry Profile www.cmpministries.com