CONSENT FORM TO RECEIVE HELP FROM HEAVEN’S CLINIC

I understand and agree that Heaven’s Clinic provides services that are based on religious beliefs, which are not recognized by the secular authorities in the fields of medicine or psychology as methods for healing or the resolution of psychological problems.

I also understand that all prayer and/or counseling sessions will be conducted by Heaven’s Clinic staff and/or other qualified personnel we may bring in to assist us.

I recognize that this step of faith has been helpful for many, but that no conclusions are guaranteed. I understand that I might experience heightened emotions and memories that were previously unknown or unresolved, that neither I nor anyone else knew about in advance. I understand that there is a possibility that one of more of these memories may be screened or false. I will not hold any of the participants responsible for my memories or behaviors.

I further understand and agree that any recommendations given to me regarding alternative health therapies, nutritional protocols, fitness regimens, lifestyle changes etc. are only suggestions for me to consider, they are not prescriptions or medical/psychological diagnoses.

I give my consent for this prayer and/or counseling session and hereby declare that I am in no way being forced, pressured, or coerced to submit to this form of ministry from any person or entity. I also have the right to terminate the session at any time without penalty.

I understand and agree that the Heaven’s Clinic staff also reserves the right to terminate the session at their discretion.

My full name typed below signifies the acknowledgment and agreement that I have been duly informed of my rights and have had the opportunity to obtain whatever information or professional advice I deemed necessary or appropriate prior to receiving help here at Heaven’s Clinic.