Healing Room Form

Personal Information
Name *
Are you a minor? *
Are you currently under doctor or other professional care? *
How did you hear about the NVHOP Healing Room Ministry?
Check all that apply
Spiritual Background
Do you attend church?
Have you accepted Jesus as your savior? *
Are you baptized in the Holy Spirit with the evidence of speaking in tongues?
Please read the Legal Liability Release below. Check and sign the appropriate fields if you accept.
I understand that by checking this box I agree to the Legal Liability Release. *
*Entering your name in this field constitutes a signature on this form*
Parent/Gaurdian *Entering your name in this field constitutes a signature on this form*

Legal Liability Release

I, the undersigned do hereby release Nevada House of Prayer 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 Inner Healing and Healing Room ministries 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 I am currently taking medication, or operating under the advice of a professional service, I will allow them (my 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 Nevada House of Prayer. All content will be held in confidence for the sole purpose of ministry in the above.