Healing Heart Prayer Ministry Request Form

    Please complete this application as the first step to obtaining an appointment for Healing Heart ministry.

    Upon arrival for your appointment you will be asked to sign a release of liability form. Ministry appointments cannot be granted to anyone who refuses to sign this form.

    Your name will be added to a waiting list in our Healing Heart ministry. Your information will be kept confidential by the administrator and administrative staff overseeing this ministry. A copy of your application will be given to the leader of The Healing Heart ministry team you are assigned to. This is for purposes of prayer and preparation of the ministry team.

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

    The Rock Healing Heart ministry does not provide home visitation, family or personal intervention or crisis ministry. At this time, we do not provide any on-giong support group ministry. This ministry depends upon trained and equipped volunteers and will strive to coordinate appointments around their availability. You will be asked to indicate the best times of the day and week that you are available for ministry. We will do our best to serve you accordingly. Donations to help support the ministry are highly appreciated.

    Failure to keep an assigned appointment will result in loss of priority in scheduling a new appointment. If for any reason you will not be able to keep your appointment, you must make every effort to call 303-688-0777 to contact Rae or email rae@therock.org PRIOR to your appointment to let us know you must cancel and reschedule.

    Your Name (required)

    Date (mm/dd/yyyy)


    Your Email (required)

    Phone Number (required)

    My need for ministry concerns,  DeliverancePhysical HealingEmotional Issues

    Other (Please Explain)

    Are you currently taking anti-anxiety medication?  YESNO

    Are you currently grieving the loss of a significant relationship or job?  YESNO

    Date and location where you accepted Jesus as Savior

    Were you water baptized AFTER accepting Jesus?  YESNO

    Have you been baptized in the Holy Spirit?  YESNONot Sure

    Which church do you currently consider your home church?

    Please note the day of the week and time of day you are available for ministry


    Your Message