Sick and Shut in-Prayer and Visit Request

We take seriously the invitation God offers to us to approach God’s throne of grace and healing with our prayers and petitions on behalf of those who are in need.  Please let us know when you or someone in your circle desires prayer.  

Call the church office at (718) 622-1818 and speak with our receptionist.  She will insure that your needs are communicated properly and in a timely manner.

Please print out the form below, fill and e-mail or fax to: info@concordcares.org 718-857-1638

First Name: _________________________________________________________________

Last Name: _________________________________________________________________

Hospital/location:______________________________________________________________

Address: ____________________________________________________________________

City: ________________________________________________________________________

State: _______________________________________________________________________

Zip: _________________________________________________________________________

Phone: ______________________________________________________________________

Prayer/Visit Requested By: ______________________________________________________

First Name: __________________________________________________________________

Last Name: __________________________________________________________________

Relation to above: _____________________________________________________________

Phone: _____________________________________________________________________

Email: ______________________________________________________________________

Best time to visit: ______________________________________________________________

Day:________________________________________________________________________

Time: _______________________________________________________________________

Frequency: ___________________________________________________________________

Daily _____

Weekly _____

Monthly _____