Divine Healing Testimonial Worksheet

Complete this form online or download  and fax to 716-685-3908, or mail to 3792 Broadway St., Cheektowaga, NY 14227


Report made by E-mail address

Client’s name City State

Client’s e-mail address Client’s phone number

Infirmity prayed for Date

People praying  

Length of time in prayer    # of times prayed for previously

First Prayer
Reduction of pain %  Time taken
Infirmity healed % Time taken

Second Prayer
More reduction of pain % Time taken
Infirmity healed % Time taken


Check tools used: 
confessed sins 
entered God’s presence 

received revelation on root cause
commanded pain to leave 
commanded demons to leave 

spoke specifically to body parts to be healed 
teamed up for greater revelation 
used oil
forgave anyone brought to mind 
broke generational sins and curses 
severed ungodly soul ties 
replaced negative beliefs 
renounced inner vows 
broke word curses 
inner healing 
saw light enter specific body organ 
felt heat 
felt energy/tingling 
2-5 people gave a 15-minute divine radiation treatment
got feedback regularly from client 
with eyes of heart saw the healing complete 
praised God for the completed healing


Names of demons cast out:


Written summary:  
Record a summary of the revelation received during prayer time and the results of acting upon this revelation. If the revelation was received by the sick person – put their name next to that revelation. Also record below and on the back of this page a full summary description of the healing ministry that took place and discuss any medical confirmation of the healing. To help us connect medical confirmation which you send at a later date, please provide the infirmity that was prayed for, the date of the prayer and the person who received the prayer. Thank you!