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Name:___________________________
Identification Number:___________
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| 26. Hearing voices/thoughts that: | ||||
| (a) condemn you severely | Yes | No | Unsure | |
| (b) blaspheme God, Jesus of Nazareth, the Holy Spirit, or Christians | Yes | No | Unsure | |
| (c) urge immoral activities | Yes | No | Unsure | |
| (d) urge suicide | Yes | No | Unsure | |
| (e) urge homicide | Yes | No | Unsure | |
| (f) urge illegal activities | Yes | No | Unsure | |
| (g) urge destructive actions | Yes | No | Unsure | |
| (h) urge sexual assaults on others | Yes | No | Unsure | |
| (i) urge perverse sexual acts | Yes | No | Unsure | |
| (j) urge severing relationships with Christian pastor/counselor/church | Yes | No | Unsure | |
| (k) speak against Christian pastor or counselor | Yes | No | Unsure | |
| 27. Seeing "monsters" | Yes | No | Unsure | |
| 28. Seeing demons | Yes | No | Unsure | |
| 29. Seeing dark shapes/shadows | Yes | No | Unsure | |
| 30. Seeing "fairies" | Yes | No | Unsure | |
| 31. Seeing "nature spirits" | Yes | No | Unsure | |
| 32. Contact with an "ascended master" | Yes | No | Unsure | |
| 33. Feelings of being choked or unable to breathe when attempting prayer to God or Jesus of Nazareth | Yes | No | Unsure | |
| 34. Hearing "growling" sounds inside the body or head | Yes | No | Unsure | |
| 35. Unable to pray to God or Jesus of Nazareth | Yes | No | Unsure | |
| 36. Unable to read the Bible | Yes | No | Unsure | |
| 37. Unable to understand the Bible | Yes | No | Unsure | |
| 38. Urge to destroy a Bible/actual destruction of a Bible | Yes | No | Unsure | |
| 39. Severe depression | Yes | No | Unsure | |
| 40. Outbursts of rage | Yes | No | Unsure | |
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Copyright 1996 Rex W. Rosenberg
All Rights Reserved