Mark B. Meyers ©Confidential

May 2012 Version

HEALING MINISTRY

BACKGROUND QUESTIONNAIRE

Name:

Age:

Email:

Year Saved (describe conversion circumstances):

Introduction

“The Kingdom of God consists not of words, but of power.”

The purpose of this Healing Ministry, in accordance with the Scriptural model, is to give the Living God, who loves you just as He loves Christ Himself, with an everlasting covenant love, the opportunity, which He relishes, to fight for you and to confront His supernatural Enemies who violently oppose Him, in His desire to favor, bless, and exalt you and thus glorify His Great Name.

As set forth in the Disclaimer at the end of this Questionnaire, I am not a counselor, doctor, therapist, or health professional. I am merely a brother in Christ who is willing to use the authority every believer has been given in Christ to provoke that confrontation so as to enable Him to free you from the torment that you are presently experiencing.

Questionnaire Background

The premise of both the Questionnaire and Healing Ministry is that emotional and physical affliction of both unbelievers and believers derive from the AdamicCurse (See Genesis 3) on all mankind for being a race of rebels, in effect, for perpetuating treason against a good King – the Lord of Heaven and Earth. Deuteronomy 28 makes it clear that the Curse includes every kind of mental and physical torment. The Enemy, in effect, legally torments us because of the existence of the Curse upon us as rebels.

However, Christ has redeemed believers from the “Curse of the Law, having become a curse for us” (Gal. 3:13). Therefore, the Curse no longer has any legal right to stick to us, because it was placed on Him on the cross (Mat. 8:16-18). That is Good News!

Unfortunately, the Enemy is himself a rebel and a criminal, and does not readily concede the fact that he has no more legal right to afflict us. The giants of Canaan did not leave the Promised Land just because the Lord announced that He had given it to Israel. The Israelites had to fight – to go in and take it. Likewise, just because the Lord has freed us from the Curse does not mean that we will not be afflicted. Fortunately, however, it does mean that we have the power and right to be free by fighting – by repenting of our rebellion and asserting our authority in Christ over the afflicting Enemy.

Healing ministry, therefore, is merely the assertion of (i) the believer’s right through repentance and the pleading of the blood of Christ over His (and his ancestor’s) sins and (ii) our authority over the Enemy in Christ, to be free from the Curse of the law and any resulting torment.

Luke 9:1 and Matthew 10:1 make it clear that in the Name of Christ believers have authority over “unclean spirits and every kind of sickness and disease.” Again, that authority must be exercised for freedom from the Curse to be realized, for the Enemy to be evicted. The Scriptures take pains to point out that Christ and the disciples practiced healing and deliverance ministry regularly in the Gospels and the Book of Acts. Christ came to “destroy the works of the devil” (1 Jhn. 3:8) and He “healed all who were oppressed by the devil” (Acts 10:38).

According to the ministry model utilized by Christ and the disciples, this authority is exercised, not by praying, but by commanding those under our authority to cease their affliction against us. This is consistent with Peter’s exhortation to “submit yourselves to God. Resist the devil and he will flee from you.”

Healing and deliverance ministry today is the continuation of the Lord’s ministry and practice of “healing the oppressed” and “freeing the captives” (Lke. 4:18), for the Scriptures make it clear that Christ is as compassionate today as He was when He walked the earth. He “is the same yesterday, today, and forever” (Heb. 13:8). As Christ was sent by the Father into the world “to heal all who are oppressed by the devil”, so we are also sent by Christ – for the same purpose (Jhn. 17:18; Jhn. 20:21).

Therefore, we who are one with Christ (1 Cr. 6:17) are His hands and feet today on this earth and we continue the practice of delivering those tormented by the Enemy and are assured the power to do so. (Lke. 10:19; Jhn. 14:12).

Questionnaire Purpose

The purpose of the Questionnaire is to identify areas in your life, or just as importantly, the lives of your ancestors (Ex. 34:6,7), which might have provided a particular opportunity or right for the Enemy to afflict you. The law of sowing and reaping is a fundamental fact of our universe. Besides our all being generally subject to the Curse, we can by our choices (or the choices of others with whom we interface) enable the Enemy to develop specific footholds and strongholds within our lives to further torment us. It can be a sin (pornography), a traumatic experience (abuse by another), or occult involvement (e.g., masonry lodge affiliations).

Once the areas are identified in the Questionnaire, I will incorporate them into a prayer designed for the specific purpose of eliminating the Enemy’s legal right to torment you further. Consider it to be similar to a person being granted a lease to occupy a certain building. The lease is a legal right granted the person to occupy the premises. Until the lease terminates the person has a legal right to remain in the building. The purpose of the prayer is to terminate the legal right of the Enemy to occupy parts of your life by enforcing the cancellation of the Curse upon your life, by bringing the subject areas of your life under the authority and the atoning blood of Christ.

The goalof ministry is nothing less than supplanting the Kingdom of Darkness with the Kingdom of God in all areas of your life.

Explanation/Description Section

The purpose of this part of the Questionnaire is to be specific about the areas of our life (or our ancestors) which require prayer. A person could ask the Lord to forgive “all of my sins” and that prayer is OK, but when dealing with the Enemy and serious affliction we want to be as specific as possible to ensure as complete a freedom as possible. Therefore, when filling this out be specific enough to let the Lord know that you agree with Him that certain conduct (by you or your ancestors) was sinful, that you are sorry for it, and you desire to be set free from its curse. The Enemy is a legalist, and within reason is entitled to require that the specific conduct which gave him the legal right to occupybe specifically repented of before he is stripped of such right.

Important Notes

Confidentiality: This form will be kept for 6 months and then deleted unless you agree that further ministry at that point is still required.

Confession: James 5:16 says: “Confess your sins to one another…that you may be healed.” Should you not want to divulge certain information, that is your prerogative. In that event, however, I cannot incorporate it into the prayer. YOU WILL BE RESPONSIBLE FOR REPENTING AND CONFESSING THAT SIN TO ANOTHER PERSON TO ENSURE THAT IT NOT PROVE TO BE A BARRIER TO MINISTRY. (But see note below). Prior to our getting together for ministry, you would use the form on your own as set forth in the prayer I will send to you to repent of and renounce that particular sin.

Caution: I am not a medical or health professional. Therefore, please do not disclose any illegal activities as your disclosure to me would not be entitled to a confidentiality privilege under the law. I would be required to report any illegal conduct to the appropriate authorities. Any such conduct should be confessed to a pastor or spouse.

Please fill out this Questionnaire and simply save it as a WORD document and attach it to an email to return to me. Alternatively, you can hand-deliver it to my mailbox or home.

Please be as complete and thorough as possible. Give this serious and thoughtful consideration. It is important to ministry success.

Here is an example of how to fill out the form:

ITEM – Are you presently experiencing: / Did your ancestor (parent, grandparent, etc.) experience? / EXPLANATION/DESCRIPTION
Unforgiveness? _X_ / X / I cannot forgive my first husband because of ….etc.
Also, my father was unforgiving of his father because of …etc

QUESTIONNAIRE

EMOTIONS

Check an item below only if your answer is “Yes”. If “Yes”, please give a brief explanation/description.

ITEM – Are you presently experiencing: / Did your ancestor experience? / EXPLANATION/DESCRIPTION
Resentment? __
Unforgiveness? __
Bitterness? __
Grudge? __
Rejection? __
Humiliation? __
Anger? __
Envy? __
Hate? __
Lust? __
Depression? __
Suicidal Ideation? __
Self-pity? __
Fear? __
Self-condemnation? __
Other Negative Emotion? __

RELATIONSHIPS

Check Item only if your answer is “Yes”. If “Yes”, please give brief explanation/description.

ITEM – Did you have difficult relationships with: / Did your ancestor have difficult relationships with? / EXPLANATION/DESCRIPTION
Father? __
Mother? __
Sibling? __
Grandparent? __
Spouse __
In-law? __
Friends? __
Other relatives? __
Other person? __

ADDICTIONS

Check Item only if your answer is “Yes”. If “Yes”, please give brief explanation/description.

ITEM – Have you engaged in high usage of or are you addicted to: / Did your ancestor engage in high usage or was he/she addicted to: / EXPLANATION/DESCRIPTION
Alcohol? __
Cigarettes? __
Marijuana? __
Speed? __
Other drugs/pills? __
Shopping? __
Food? __
Music/Movies/TV? __
Sex? __
Books/Magazines?
Pornography? __
Video Games? __
Gambling?
Sports watching? __
Other? __

SEXUAL MATTERS

Check Item only if your answer is “Yes”. If “Yes”, please do not give any explanation.

ITEM – Have you engaged in: / Did your ancestor engage in: / EXPLANATION/DESCRIPTION - NOT NECESSARY
Fornication? __ / Do not provide Explanation/Description
Homosexuality? __ / Do not provide Explanation/Description
Lesbianism? __ / Do not provide Explanation/Description
Adultery? __ / Do not provide Explanation/Description
Voyeurism? / Do not provide Explanation/Description
Exhibitionism? __ / Do not provide Explanation/Description
Abnormal Activites? __ / Do not provide Explanation/Description
Masturbation? ___ / Do not provide Explanation/Description
Other? __ / Do not provide Explanation/Description

SELF-TREATMENT

Check Item only if your answer is “Yes”. If “Yes”, please give brief explanation/description.

ITEM – Have you engaged in or have: / Did your ancestor engage in: / EXPLANATION/DESCRIPTION
Cutting? __
Tattos? __
Piercings? __
Sniffing? __
Pulling hair out? __
Nail-biting?
Other? __

OCCULT

Check Item only if your answer is “Yes”. If “Yes”, please give brief explanation/description.

ITEM – Have you experimented with or are you adept at: / Did your ancestor engage in or was he/she adept at: / EXPLANATION/DESCRIPTION
Witchcraft? __
Wicca? __
Sorcery? __
Ouija Board? __
Seance? __
Spiritism? __
Transcendental Meditation? __
New Age? __
Self-realization? __
Hinduism? __
Zen/Buddhism? __
Freemasonry? __
Secret Society?
Palm Reading? __
Tarot? __
Horoscope? __
Voodoo? __
Psychic healer? __
Acupuncture? __
Martial Arts? __
Yoga? __
Hypnosis? __
Other religion? __
Other experience? __

OCCULT OBJECTS

Check Item only if your answer is “Yes”. If “Yes”, please give brief explanation/description.

ITEM – Do you possess: / Did your ancestor have: / EXPLANATION/DESCRIPTION
Good luck charm? ____
Pictures of Jesus? __
Pagan statues? __
Occult pictures/statues (dragons, witches, zombies, vampires, etc)? __
American Indian, African, or pagan objects? __

ILLNESS

Check Item only if your answer is “Yes”. If “Yes”, please give brief explanation/description.

ITEM – Have you experienced: / Did your ancestor have: / EXPLANATION/DESCRIPTION
Heart Problems? __
Cancer? __
Arthritis? __
Blood/Circulation? __
Fybromyalgia? __
Diabetes?
Asthma/Allergies? __
Pain?
Headaches? __
Stomach Problems? __
Anorexia/Bulimia? __
Other? __

BEHAVIOURAL ISSUES

Check Item only if your answer is “Yes”. If “Yes”, please give brief explanation/description.

ITEM – Have you engaged in (ongoing): / Did your ancestor engage in: / EXPLANATION/DESCRIPTION
Gossip? __
Meddling? __
Cursing? __
Back-biting? __
Pride? __
Unbelief?
Blasphemy? __
Sloth? __
Dishonesty/Lying? __
Gluttony? __
Other? __

TRAUMA

Check Item only if your answer is “Yes”. If “Yes”, please give brief explanation/description.

ITEM – Have you experienced previous or ongoing: / Did your ancestor experience: / EXPLANATION/DESCRIPTION
Accident? __
Surgery? __
Neglect? __
Teasing? __
Abortion? __
Rape?
Incest? __
Molestation?
Isolation? __
Violence? __
Abuse? __
Other? __

Be honest, what are your favorite three TV shows?

Be honest, what are your favorite three movies?

Be honest, what are your favorite three books?

DISCLAIMER/ACKNOWLEDGMENT/RELEASE

I, THE UNDERSIGNED, ACKNOWLEDGE AND AGREE THAT :

-NO WEB PAGE OR EMAIL RESPONSE OR OTHER COMMUNICATION IN RESPECT OF THIS WEBSITE OR MINISTRY SHOULD BE CONSTRUED AS COUNSELING, THERAPY, LEGAL, OR OTHER PROFESSIONAL ADVICE IN ANY WAY WHATSOEVER. AS SUCH, IN CONSIDERATION FOR USING THE SERVICE OF MARK B. MEYERS AND HIS MINISTRY TEAM, I HEREBY FOREVER RELEASE MARK B. MEYERS AND HIS MINISTRY TEAM FROM ANY LIABILITY FOR ANY DECISION I MIGHT MAKE IN MY LIFE OR ANY CONSEQUENCES OF MY RECEIVING MINISTRY.

I, THE UNDERSIGNED, FURTHER ACKNOWLEDGE AND AGREE THAT MARK B. MEYERS:

-IS NOT A THERAPIST, COUNSELOR, MINISTER, OR MEDICAL OR MENTAL HEALTH PROFESSIONAL

-CLAIMS NO SPECIAL MEDICAL OR HEALTH KNOWLEDGE AND OFFERS NO MEDICAL ADVICE

-WILL NEVER TELL ME TO IGNORE DOCTOR’S ORDERS OR MEDICAL RECOMMENDATIONS FROM HEALTH PROFESSIONALS

-WARRANTS NO PARTICULAR RESULTS

-IS MERELY A BROTHER IN CHRIST WHO I HAVE ASKED TO HELP ME

-OFFERS TO PRAY OVER ME AS A FAVOR TO ME AND CHARGES NOTHING FOR HIS EFFORTS

-RELIES SOLELY ON THE LORD JESUS, AND NOT HIMSELF, TO HEAL YOU

______

SIGNATURE/NAME/DATE