I agree that by completing this form, this substitutes as my signature. I release Healing Room Ministries, the Healing Rooms Bensenville 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 body of Christ, and reflecting many denominations and churches. They are not trained nor licensed professionals of counseling, therapy or medical services. I understand that if I 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 for Healing Rooms Bensenville and Healing Rooms Ministries. All content will be held in confidence for the sole purpose of my individual ministry.