HEALING
Repentance/Confession Worksheet
Name______________________________________________ Date_____________________
1. Type of sin. __________________________________________________________
(ex. sexual impurity, fornication, adultery, stealing, lying, violence, homosexuality, drugs or alcohol abuse, gossip, spreading discord, fear and terror, traumatic events, etc.)
2. Give a brief description
of the incident.
3. Name the people involved.
4. Have you confessed your sin to the Lord Jesus Christ? ______ Date Confessed: ____________
5. Have you repented (changed your behavior)? _______________ Date: ____________________
6. Have you asked the other people involved to forgive you? _____________ Date: ___________
7. Have you made restitution? __________________________________ Date: _______________
Do you plan to make restitution?
________ When: ___________________________________
What is proper restitution in this case?
8. Have you renounced any spiritual powers involved in your sin? _________ Date: ___________ What were they?
9. Have you received forgiveness from God for your sin? ______ Date __________________
Forgiveness from others? _______ Date: ___________________
10. Have you forgiven yourself? __________ Date: _________________
11. Have you forgiven others involved with you in this sin? ________ Date: ________________
Have you prayed a prayer of blessing or released them? _____________Date______________
12. (James 5:16) Have you confessed your sin to other brethren and been prayed for that you might be
healed? Date: ___________ Who Prayed with you? ______________________________
13. Jesus came to bind up the broken-hearted. Do you have painful memories? ________Have
you forgiven the people involved? ______ Have you forgiven yourself? ______ Have you prayed a
prayer of blessing and released them?________ Have you given the pain to the Lord?_____ Date_______
14. In memories of sexual relationships have you repented?_______ Have you forgiven the other
person? _______Have you forgiven yourself? ______Have you prayed a prayer of blessing and
released them? ______ Have you broken soul ties?_____ (Taken back what the other person took
from you and given back what you took from them) Date_______________
15. Fear and terror has torment. Have you asked the Lord to take the fear and terror? _________
Date_______________________ Have you asked Him to fill all the areas with His Love? _____
God's perfect love casts out all fear.
16. Wherever the enemy had a stronghold have you asked the Lord to fill that area with His
presence?__________.
This information is released voluntarily Date____________
(Signed)_________________________________
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