I,                                                                            , acknowledge that team members from Nephros Ministries have voluntarily agreed to pray for me using inner healing methods. I understand that this session is not a professional counseling meeting and that none of the team members are licensed counselors. I understand that the team members are, to the best of their ability and under the leadership of Nephros Ministries doing what they can to agree with God’s
Word and God’s leading to help me achieve more freedom in my life. I state that I have voluntarily sought assistance and that I am under no obligation to accept or reject any of the advice or help that I might receive from the team members of this ministry.

I understand that if I receive ministry, the team is committed to respect the disclosed information and will maintain a pastoral level of confidentiality. This information, as given in writing from me, may be shared with other persons involved in my healing process. Nephros Ministries is required to follow the rules of mandated reporting. We are required by law to report:

1. Any intent of a person to take harmful, dangerous, or criminal actions against another person or against him or herself.

2. Any act of child or elderly abuse or neglect.

 

I agree to hold Nephros Ministries and its team members free from any and all liability, loss, or damage of any kind that may arise as a result of assistance that I have received or from my involvement with Nephros Ministries.

I give permission for this Nephros Ministries to discuss my situation with the following individuals:

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