Free & Fearless Inquiry Session - Fearless Unite

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Confidential – For the Fearless Ministry Team Use Only

This form helps us understand your story so we can walk with you in love, prayer, and truth. Every answer is held in complete confidence and is only used to help you experience freedom through Jesus. It also helps us get to know you more quickly so we can better understand the root of your struggle and walk with you toward healing and freedom without delay.

11/29/25

client

Age

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Relationship Status

Single In a realtionships Married Divorced Widowed{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Single \nIn a realtionships\nMarried \nDivorced \nWidowed"}

Church Name (if attending)

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Spiritual Background

Have you accepted Jesus Christ as your Lord and Savior?

Yes No Unsure{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo\nUnsure"}

Have you been water baptized by your choice?

Yes No Unsure{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo\nUnsure"}

How would you describe your prayer life?

Strong & Consistent Inconsistent Struggling Non-existent{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Strong & Consistent \nInconsistent \nStruggling \nNon-existent"}

How would you describe your Bible reading habits?

Daily weekly occasionally rarely never{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"Daily\nweekly\noccasionally\nrarely\nnever"}

Have you ever been involved in the occult, witchcraft, new age practices, or false religions? Examples could be Crystals, rocks, light work, etc.

Yes No{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

If yes, please specify

{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}

Have you ever consulted psychics, tarot cards, astrology, or mediums?

Yes No{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

Have you ever taken part in or been dedicated to non-Christian religious practices?

Yes No{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

If yes, please specify

{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}

Have you ever experienced supernatural occurrences such as seeing spirits, hearing voices, or paranormal activity?

Yes No{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

If yes, please specify

{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}

Family & Generational Background

Have any of your family members ever practiced things like witchcraft, spells, tarot, astrology, freemasonry, or belonged to secret groups that don't honor Jesus?

Yes No{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

Are there patterns of addiction, abuse, or mental illness in your family?

Yes No Unsure{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo\nUnsure"}

Has there been a history of suicide, early death, or tragic accidents in your family?

Yes No{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

Have you experienced significant rejection, abandonment, or broken relationships in your family?

Yes No{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

Areas of Struggle

Do you struggle with persistent fear, anxiety, or depression that seems unexplainable?

Yes No{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

Do you have uncontrollable anger, rage, or violent thoughts?

Yes No{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

Do you struggle with intrusive thoughts of self-harm or suicidal ideation?

Yes No{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

Do you experience tormenting nightmares or night terrors?

Yes No{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

Have you had sleep paralysis, demonic attacks, or unexplained physical afflictions?

Yes No{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

Do you struggle with sexual sin? Check that apply:
Pornography Sex outside of marriage Adultery Sex chatting (sending nude or sexual in nature photos) Lust (or lustful thoughts or dreams) Masturbation Same sex attraction{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Pornography\nSex outside of marriage\nAdultery \nSex chatting (sending nude or sexual in nature photos)\nLust (or lustful thoughts or dreams) \nMasturbation\nSame sex attraction"}

Do you have addictive behaviors?

drugs alcohol gambling food or lack of food social media overspending{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"drugs\nalcohol\ngambling\nfood or lack of food\nsocial media\noverspending"}

Have you ever made covenants, vows, or agreements with ungodly people, organizations, or spirits?

Yes No{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

Unforgiveness & Inner Healing

Do you hold unforgiveness, resentment, or bitterness toward anyone?

Yes No{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

If yes, please specify

{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}

Have you been involved in abusive relationships (verbal, emotional, physical, sexual)?

If yes, please specify

{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}

Have you suffered from deep emotional wounds, trauma, or rejection?

If yes, please specify

{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}

Have you ever made inner vows (e.g., "I will never trust anyone again")?

Yes No{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

Curses, Bondages, and Strongholds

Do you feel blocked, oppressed, or held back spiritually, emotionally, or financially?

Yes No{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

Do you experience unexplainable bad luck or repeated failures?

Yes No{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

Have you spoken curses or negative words over yourself (e.g., "I will never succeed")?

Yes No{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

Have you engaged in blood covenants, self-harm, or oaths involving your blood?

Yes No{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

Do you hear voices or feel controlled by unseen forces?

Yes No{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

Willingness

Are you willing to fully surrender your life to Jesus Christ?

(This means you're ready to let Him lead your life instead of trying to handle everything on your own.)

Yes No{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

Are you ready to renounce any past involvement in occultism, sin, or demonic influences?
(This could include things like using Ouija boards, horoscopes, tarot cards, or knowingly choosing sin even when you felt God tug at your heart.)

Yes No{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

Are you committed to walking in freedom by following Jesus and resisting temptation?
(This means choosing what’s right even when it’s hard—like asking for help instead of turning to alcohol, self-harm, sex, or isolation.)

Yes No{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}