Testimony and Testimony Release Form Wellbeing / Healing Centre / Testimony and Testimony Release Form PURPOSE: Our desire is to give glory to God for His love and power and encourage the family of God to trust Him for healings and miracles. Your testimony will be used to tell God’s continuing story of what He is doing and has done. If you wish your name to be withheld please indicate this at the end of the form.First Name* Last Name* Email* 1. What did you receive prayer for?*2. Did you have a doctor's diagnosis? If so, what was it?*3. How severe was the injury, sickness or disability?*4. How long had you had this condition?*5. What happened as a result of prayer?*TESTIMONY RELEASE FORM I understand that my testimony may be used to describe what happened to me and I authorise Eastgate to release the testimony with the inclusion of any biographical information that I have provided. I do not expect any monetary reimbursement for the use of this testimony and waive my right to inspect or approve of any finished product.Consent*Please confirm that you have read the statement above and consent to the uses stipulated. I consent to the uses stipulated Please indicate your age* 18 or over Under 18 Please withhold my name from this testimony* No Yes CAPTCHA