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Healing Rooms of Loveland
Online Ministry Request

Name:
Cell Phone Number:
(So we can text you when a team is ready)
Email Address:
(So we can email you if necessary)
Preferred Contact Method:
(So we know how to contact you when a team is ready)
Text Message (reliable, fast)
Email Message (reliable, slower)
Phone call (less reliable, slower)
Type(s) of Ministry Desired: Healing
Prophetic
Address:
City, State, Zip
Spouse’s Name:
Church Affiliation:
Children? Yes    No
Born Again?
(Have you asked Jesus into your heart?)
Yes    No
Baptized in the Spirit?
(Do you have a prayer language?)
Yes    No
Are you over the age of 18? Yes    No
If not, name of parent/guardian:
Under a doctor’s care?
(or other health professional)
Yes    No
Prayer Need:
How did you hear about the
Healing Rooms of Loveland?
Legal Liability Release
I, the undersigned, do hereby release Healing Rooms Ministries, the Healing Rooms of Loveland, 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 a staff of volunteers representing the broad body of Jesus Christ and reflect many denominations and churches. They are not trained or licensed professionals of counseling, therapy, or medical service. I will allow my medical professionals (medical doctor, therapist, counselor, etc.) to confirm any results of prayer received before altering any prescribed course of action. I understand this form and all data recorded on it is the sole property of the Healing Rooms of Loveland. All content will be held in confidence for the sole purpose of the ministry to the above.

By checking this box, I certify that I understand and agree to abide by the above Legal Liability Release. I Agree