Healing Ministry Intake Form

But He was wounded for our transgressions, He was bruised for our iniquities; the chastisement for our peace was upon Him, and by His stripes we are healed. -Isaiah 53:5



Note: this is for identifying purposes only. We have many people with the same first and last name so this helps us make sure we are following up appropriately.

















Liability Waiver
I acknowledge that ministry members and volunteers from the Rock Church San Diego Healing Ministry have voluntarily agreed to pray for me. The ministry members and/or volunteers are not medical or mental health care professionals and should not be substituted for any care you receive by any medical or mental health professional. We do not perform psychiatric evaluations nor do we prescribe medication.

I understand that these ministry members and volunteers are praying to God the Father, Jesus the Son and the Holy Spirit. The ministry members and volunteers are Holy Spirit filled believers who have been trained in supernatural and divine healing techniques. I understand that Rock Church is a nonprofit California Corporation that makes no charge for its services. I further state that I have voluntarily sought assistance of my own initiative and that I am under no obligation to accept or reject any of the advice or help that I might receive from the ministry members or volunteers. I understand that if I receive ministry from the Rock Church San Diego Healing Ministry, the team is committed to respect the disclosed information, but not to complete confidentiality. The information, as needed, may be shared with other Rock Church leaders and/or Healing Ministry team members. I understand that members of any Rock Church San Diego ministries are California state mandated reporters for child and elder abuse. I agree to hold Rock Church and its team members free from all liability, loss or damage of any kind that may arise as a result of assistance, which I have received, or from my involvement with the Rock Church San Diego Healing Ministry.

Please consult your own physician, mental health provider, or appropriate health care provider, about any recommendations or opinions regarding any medicines. We do not offer any opinions nor recommend that you stop taking any medicines or therapy. Never discontinue treatment or medication without first consulting your physician, clinician or therapist.

I voluntarily agree to participate in the Rock Church San Diego Healing Ministry prayer session. I understand and assume all risks in participating in Rock Church San Diego Healing Ministry prayer including, but not limited to, any physical and/or emotional responses or reactions because of prayer.

During the prayer session, I acknowledge that I may receive personal prayer, communion, anointing with oil, inner healing prayer, personal deliverance from demonic spirits, biblical scripture, biblical instruction, and any other Christian practices that could be useful in ministering to me.

I have read this disclaimer and release of liability and understand and agree with it and have executed it as my free and voluntary act. 


Hidden Fields