Patient Registration

Religious belief

Real full name

Biological sex
Select… Female Male Intersex Prefer not to say

Self-identified gender

Age

Location (country and state/province)

Languages used

Occupation

Instant messaging app / handle

Official diagnosis

Self-diagnosis / your own account

Spirit / ghost estimate · quantity
If you cannot estimate, write “Don’t know” / 不知道.

Spirit ability axis (X–Y–Z self-score)
Score from the Second Deliverance grades. Open grades & harm →
If you cannot assess the X–Y–Z numbers, write “Don’t know” / 不知道.
The clearer your condition notes are, the higher your review priority and the more readily you can be scheduled. This does not buy grace or a guaranteed slot.

See Release Process · priority principles. Contribution does not buy grace or a guaranteed schedule.

Special contribution (major constructive help)?
Select… Yes — I can offer major help to STDMC No — apply under A / B / C / D

Explain the special contribution (required if yes; optional if no)
Examples: Video-EEG centers, summoning shepherds, discipline-center network, public influence, designated gift. Do not boast or break a promise.

Special value of the condition (research / witness value)

Identity selection (four priority classes)
Select… A — Real-name witness + public reach + willing to become Shepherd / First-Hand Evidence Witness B — Real-name witness + willing to become Shepherd / First-Hand Evidence Witness C — Real-name witness only D — Anonymous / handle witness only If you claimed major contribution above, still choose the class that matches your witness willingness.

I confirm that I am an adult, or that a lawful guardian will complete the relevant consent process.

I understand this is religious ministry, not medical or emergency care, and I will not change or delay professional care because of this request.

I have read the ministry informed-consent terms and understand that a request is subject to human review.