IAHR PRAYER AND HEALING ROOMS
Prayer Ministry Request

If you would like people to pray for your needs, in person, at the Prayer and Healing Rooms location at 526 Old Liverpool Road, between 4:00 PM and 7:45 PM, you can come and wait your turn. When a room opens, we will take the next person in line. However, those who have requested a ministry time by completing the form below take precedence. It is important you answer all questions before pressing the "Submit" button.

If you are not able to physically come to the Prayer and Healing Rooms, we will from time to time, conduct online ministry via Zoom. Space is limited and there is no firm schedule. However, you can submit a Zoom Ministry Prayer Request and someone will get back to you by clicking here

It is important that you fill in as much information as you are comfortable with, including your name and prayer need. However, the COVID questions must be completed in their entirety. Be sure to include your email, because that is how we will communicate with you. When you reach the bottom of the form, sign the form by printing your name, and then click on Submit. After we receive your information, we will send your appointment time and instructions about how to enter the online Prayer and Healing Rooms.

First Name: Last Name:
Email Address:
Phone:
Mailing Address line 1:
Mailing Address line 2:
City, State, zip/country code:
Home Church:

The following questions will help the team pray more effectively:

How did you hear about the Healing Rooms?
Are you currently under Doctor or other Professional Care?
Did you invite Jesus into your life? (John 3:3)
Are you Water Baptized by immersion
Baptized in the Holy Spirit? (John 1:33)
Are you Married?
Do you attend church?

Have you tested positive for COVID-19 in the past 14 days? (Yes or No)

Have you knowingly been in close or proximate contact in the past 14 days with anyone who has tested positive for COVID-19 or who has or had symptoms of COVID-19? (Yes or No)

Have you experienced any cold or flu-like symptoms in the last 14 days such as: Fever or chills, Cough, Shortness of breath or difficulty breathing, Fatigue, Muscle or body aches, Headache, New loss of taste or smell, Sore throat, Congestion or runny nose, Nausea or vomiting, Diarrhea (Yes or No)

Do you have any of the following conditions: Asthma, Chronic Kidney Disease, Chronic Lung Disease, Diabetes, Immuno-compromised, Lung Disease, Serious Heart Conditions, Severe Obesity? (Yes or No)

By submitting this Prayer Request you are agreeing to the following: I, the undersigned do hereby release The IAHR Healing Rooms, The Healing Rooms of Greater Syracuse, To His Glory Ministries and all their volunteers or staff from any liability, for any harm or perceived harm resulting from my voluntary receiving of ministry in accordance with Mark 16:15-18 on this and subsequent visits. I recognize and aknowledge that during the COVID crises that all City, County and State safety protocols have been followed. I understand that these Healing Rooms are staffed by volunteers representing the broad body of Christ and reflect many denominations and churches. They are not trained or licensed professionals of counseling, therapy or medical services. I understand that if I am currently taking medication, or operating under the advice of a professional service, I will allow them (my medical doctor, therapist, counselor etc.) to confirm any results of prayer received before altering their prescribed course of action.

By Printing my name, I agree with the above and sign electronically by printing my name:

Prayer Request:

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