The undersigned acknowledges that the Practitioner does not diagnose or prescribe for medical or psychological conditions nor claim to prevent, mitigate or cure such conditions.  The Practitioner does not provide diagnosis, care, treatment or rehabilitation of individuals, nor does the Practitioner apply medical, mental health or human development principles, but ministers to the suffering by prayer, spiritual, religious or mental means, without the use of any drug material remedy or physical manipulation and provides Ministerial Counseling under the seal of confidentiality.

  The undersigned give Informed Consent to the services that will be provided.  The undersigned hereby releases the Practitioner (and Church and all its local units, auxiliaries, affiliated organizations, ministers and agents) from all claims and liabilities arising from the use or misuse of spiritual, mental, bioenergetic and/or nutritional modalities, indemnifying and holding the Practitioner harmless from all claims and liabilities there from, whatsoever.  The Practitioner reserves all rights.