Name* First Last Email* Name of responsible adult if accompanying someone under 18 First Last Address* Street Address Address Line 2 City County Postal Code What is the physcal issue you would like prayer for?*Acknowledgement I have read the Healing Centre Welcome Leaflet Eastgate Healing Centre is not a medical centre and does not and will not dispense medical advice. I will not stop or change any prescribed medication or other form of treatment that I am currently receiving without consulting my doctor or relevant practitioner. I will not remove any brace or medical device etc that I have been advised to wear continuously without seeking medical advice I am aged 18 or over I am accompanied by a responsible adult Eastgate or any of its workers (voluntary or otherwise) are not legally liable for my health which remains my responsibility * I acknowledge the above
