Healing Rooms

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Born Again*
Baptized in the Holy Spirit*
If Minor, Name of Mother/Father
Are you currently under Doctor or other Professional Care*

I, the undersigned do hereby release Healing Rooms and their volunteers or staff from any liability, for any harm or perceived harm resulting from my voluntary receiving of free prayer on this and subsequent visits. I understand that these Healing Rooms are staffed by volunteers representing the broad body of Christ and reflect many denominations and churches. They are not trained or licensed professionals of counseling, therapy or medical services. I understand that If l am currently taking medication, or operating under the advice of a professional service, I will allow them (my medical doctor, therapist, counselor etc.) to confirm any results of prayer received before altering any prescribed course of action. I understand that this form and all data recorded on it Is the sole property of Healing Rooms. All content will be held In confidence for the sole purpose of ministry to the above.

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