Healing Prayer Session Request Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please fill out this form to request a healing prayer appointment with New Hope Church Healing team. More information will be sent to you on how this works after your form is received!

Email *

Last Name *

First Name *

Street Address *

City *

State *

Zipcode *

Phone Number *

Gender *

Female

Male

Age (must be 18 or older) *

What church do you attend?

Have you been through inner healing ministry before? If yes, enter the date (or approx. date), and context of your last session:

Are you currently under the care of a psychiatrist, psychologist, therapist, or licensed counselor? *

Yes

I am seeking prayer for: (choose all that apply) *

Physical Healing

Emotional Healing

Both!

Required

Are there any specific areas for which you are seeking breakthrough? Why are you seeking healing prayer? *

Consent for Healing Prayer & Liability release form:

**IN ORDER TO SCHEDULE A PRAYER SESSION YOU MUST READ AND AGREE TO THE FOLLOWING:

Purpose & Disclaimers:
The purpose of this ministry is for spiritual growth and healing. It is not a psychological counseling service, nor is it intended to be. New Hope Healing Team members are not licensed psychologists or psychiatrists; however, they are trained in using the Word of God and prayer through the power of the Holy Spirit. The lasting results of this approach are also contingent on the willingness of the individual to subsequently steward their spiritual breakthroughs by aligning their future choices and behaviors with the standards outlined in the Word of God consistent with the teachings of Jesus Christ and the continued ministry of the Holy Spirit.

Confidentiality:
I understand that when/if I disclose personal information relevant to my scheduled healing ministry session, the New Hope Healing ministry team is committed to respect my privacy, and to honor confidentiality. The New Hope Healing team leadership reserves the right to share relevant information only with New Hope Church trusted Senior leaders, if it becomes necessary to gain additional insight, counsel, resources and wisdom that would impact my continued healing journey. By signing this waiver I am acknowledging and agreeing to that process. In the case that confidential information is discussed outside of the actual healing ministry session, I will be notified with any additional necessary information.

In addition, New Hope Church is required by law to report to appropriate authorities:
1. Any intent of a person to take harmful, dangerous, or criminal action against another person or against himself/herself.
2. Any act of child or elder abuse or neglect.

Technology Use:
New Hope Church healing teams may leverage technology including, but not limited to, Zoom and other video conferencing platforms. New Hope Church, nor its team members, are either responsible nor liable for the use of this technology or any issues related to the privacy and security of such technology. None of the participants will record any session unless all participants agree to the same.

Release of Liability Statements:
I understand the above information concerning this ministry. I have sought this ministry of my own free will. I understand that this ministry uses the services of volunteer prayer ministers who have been trained at New Hope Church. These volunteer team members are, to the best of their ability, doing what they can to help me achieve more freedom in my life. I am under no obligation to accept or reject any of the advice or help that I might receive during this session. All personal information I reveal is given voluntarily in order to facilitate the team members who are working with me.

I agree to hold New Hope Church and its volunteer team members and staff free from any and all liability, loss or damage of any kind should this ministry session(s) not live up to my expectations.

AGREEMENT WITH PRAYER CONSENT FORM: By indicating below, I am agreeing with the above terms of the Prayer Ministry Consent & Release of Liability form. (This is a legally binding form. You will also be presented with a copy to sign and date before your prayer session begins.) Thanks for your cooperation. *

YES, I have read and agree to all the terms outlined in the Prayer Consent Form and Liability Release, and would like to schedule a prayer session.

NO, I do not agree with the above Prayer Consent form, therefore I cannot schedule a prayer session at this time.

I have a question about the terms of the Prayer Consent form before I agree. Please contact me.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of New Hope Church. Report Abuse

Forms