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Informed Consent FOrm

Church/Lay-Ministry Informed Consent for Ministry Agreement


To Whom It May Concern:
I have been given clear explanation of what Theophostic Prayer Ministry consists of and I am deliberately asking for this specific form of prayer ministry. I understand that I can educate myself further with the basic principles by reading the book "Healing Life's Hurts" by Ed M. Smith if I choose.

With this said, I voluntarily consent to be ministered to by _______________________________. I understand that some or all of the procedures used to give spiritual and emotional help through the use of the Theophostic Prayer Ministry method may or may not be clinically demonstrated as guaranteeing either short-term or long-term results. I fully understand that the ministry I receive is not counseling in any form, but rather prayer ministry. I accept this ministry fully and completely and do not hold anyone responsible for any outcome that may arise because of this ministry. I do not hold the person named above or Theophostic Prayer Ministry itself responsible for any further or additional care I may need in the future. I take full responsibility for my life, health, and well being now and in the days to come
.

I am voluntarily accepting this offer of prayer ministry, and I affirm that I understand I am free to terminate my participation at any time for any reason. I understand and take full responsibility for all consequences for prematurely terminating any spiritual intervention done for me or on my behalf. I also understand that once I leave this place of ministry, I accept full responsibility for any choices I make that may be detrimental to me. I also accept full responsibility for all aftercare and follow-up ministry, since this ministry opportunity is limited to this particular period and does not provide for any promise of future ministry.

I also fully understand that this ministry opportunity is being offered on a donation basis. I understand this is not a professional counseling office, nor are those providing ministry holding themselves out to be professional counselors, but rather as prayer ministers/facilitators. I accept this ministry opportunity as a gift and can freely give as I choose to support this cause, but am under no obligation to pay for this service should I choose not to do so. If I choose to contribute any money to this ministry, it is to be viewed as a token of my appreciation and not as payment for service rendered.

  

Signed: __________________________________________________ Date: ____________________

Printed Name: ________________________________________________

Street______________________________________________________________________________

City______________________________________State__________Zip_________________________

Witnessed by: ____________________________________________________ Date: ______________

 
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