Healing Prayer Appointment Request

Your name *

Email address *

Phone number

Age

Gender

What church are you attending, if any?

How did you hear about our Healing Prayer Appointments?

Ministry details:

What would you like to receiving healing for?

Do you know what the cause is?

Are you under a doctor’s/professional’s care for any of these needs?

Yes

Have you received prayer at Dayspring before?

Yes

Please indicate your general availability by ticking one or more of the following times:

During business hours (Monday to Friday, 9 -5pm) and/or

Outside business hours

Please indicate if you are comfortable with a mixed gender team:

Yes

Liability release *

I release Dayspring Church, their volunteers and staff from any liability, for any harm or perceived harm to me/my child resulting from the prayer ministry. I understand that if I am taking medication and/or operating under the care of a health advisor (medical doctor, therapist, counsellor, etc), I will seek the further advice of that advisor to confirm the outcome of prayer received and to obtain advice on the continuing use of medication and any other treatment regime. I agree to allow Dayspring Church to provide information by way of testimony to others about the healing or other outcomes as a result of this prayer ministry. I understand that my name or contact information will not be disclosed in the testimony.

Ministry details:

Thank you for completing your request. One of our team members will be in contact with you shortly to arrange an appointment time.