Healing Room Questionnaire

    Thank you for requesting an on-line Healing Rooms session. Please complete the questionnaire and click the SEND button at the bottom. Your responses will be sent to a monitored email inbox that only The Rock Healing Rooms leadership have access to. Your responses will be kept confidential by leadership and the Healing Rooms ministry teams.

    Our on-line Healing Rooms sessions are conducted on the first and third Tuesdays of each month from 6:30 pm to 8:00 pm. We will assign your request to the first available time slot and confirm your appointment by email. Prior to your session, you will be sent an email invitation to join an on-line meeting. You will need a computer with a camera and speakers. If you don’t have this equipment, you will need a smart phone. If you have further questions, you can email us at healingrooms@therock.org.

    If you are assigned a time slot and find you are unable to participate during your assigned time, please let us know immediately by email and we will contact you to reschedule.

    If you feel you need immediate ministry attention, you should call the Rock at 303-688-0777. The pastor on call will contact you.

    Welcome to Healing Rooms! In order to serve you better, we ask that you fill out this questionnaire before receiving ministry.

    General Information

    Is this your first visit to Healing Rooms?  YESNO

    Date (mm/dd/yyyy)

    Your Name (required)

    Are you under 18 years old? If yes, Age:  

    (Children under 18 need to be accompanied by an adult.)

    Phone Number (required)

    Your Email (required)


    Date of Salvation

    Which church do you currently consider your home church?

    Years Attended:


    Is your prayer need: physicalemotionalfinancialprophetic

    Area of Prayer Needed:

    How long have you had this?

    Do you know the cause?

    Have you seen a doctor?

    What is their diagnosis?

    Did anything happen prior to this condition?

    IMPORTANT! Do not stop taking your medication or seeing your doctor!


    Request for online healing session

    Your Message