What type of request are you submitting?
*
Prayer
Scheduled Surgery
Bereavement (Passing of a Loved One)
Home Visitation
Hospital Admission
Name
*
First Name
Last Name
Are you a Member or Visitor of The Luke Church?
*
Member
Visitor
Email
*
example@example.com
Phone Number
*
10 digit Phone Number
Address
*
Street Address
Apt, Unit or Room #
City
State / Province
Postal / Zip Code
Click here to Request:
Baptism
Baby Dedication
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Prayer Request
As a community of faith, through prayer and presence, we stand with you in times of need, sorrow, and celebration, as a reminder "You Are Not Alone!" Please complete this form to request Prayer and a member of our Luke Cares team will contact you.
Who is this Prayer Request for?
*
Please Select
Myself
Others
Myself & Others
List Names for Prayer Display
*
First and Last Name of Each Person
Would you like to receive a phone call for prayer?
*
Yes
No
Prayer Request
*
Please let us know how we may pray for you.
Include this Prayer Request in the 1st Wednesday Prayer Experience Submissions?
*
Yes
No
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Passing of a Loved One
As a community of faith, through prayer and presence, we stand with you in times of need, sorrow, and celebration, as a reminder "You Are Not Alone!" Please complete this form to inform us of a loved one having passed and a member of our Luke Cares team will contact you.
Deceased Name
*
First Name
Last Name
Are they a Member of The Luke?
*
Yes
No
The deceased relationship to you:
*
Husband
Wife
Spouse
Mother
Father
Brother
Sister
Son
Daughter
Grand Mother
Grand Father
Aunt
Uncle
Neice
Nephew
Cousin
Other
Who they are to you
Your Relationship to the Deceased
*
Date of Death
-
Month
-
Day
Year
Date
Do you have funeral arragements?
*
Yes
No
Funeral Home (Name & Phone Number)
*
Enter Funeral Home Caring for your Loved One (N/A if not yet known)
Are you considering The Luke for the service?
*
Yes
No
Date or Proposed Date of the Service?
-
Month
-
Day
Year
Date
Please provide service details
Enter: Location, Time
Are there Children (6-11) or Youth (12-18) in the deceased or your household?
*
Yes - Children
Yes - Youth
Yes - Both
No
Unsure
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Hospital Admission
As a community of faith, through prayer and presence, we stand with you in times of need, sorrow, and celebration, as a reminder "You Are Not Alone!" Please complete this form to request a Hospital Visit and a member of our Luke Cares team will contact you.
Who is Hospitalized?
*
I Am
A Loved One
Name of person Hospitalized
*
First Name
Last Name
Hospital Admitted to
*
Please share any pertinent information regarding the hospitalization
*
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Scheduled Medical Procedure
As a community of faith, through prayer and presence, we stand with you in times of need, sorrow, and celebration, as a reminder "You Are Not Alone!" Please complete this form to request a Survey Support Visit and a member of our Luke Cares team will contact you.
Who is having Surgery?
*
I Am
A Loved One
Name of person Having Surgery
*
First Name
Last Name
Scheduled Date of Procedure
*
-
Month
-
Day
Year
Date
Time of Checkin
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
15
30
45
Minutes
AM
PM
AM/PM Option
Surgery Hospital
*
Please share any pertinent information regarding surgery or condition
*
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Home Visit Request
As a community of faith, through prayer and presence, we stand with you in times of need, sorrow, and celebration, as a reminder "You Are Not Alone!" Please complete this form to request a Home Visit and a member of our Luke Cares team will contact you.
Who is Homebound?
*
I Am
A Loved One
Name of Homebound
*
First Name
Last Name
Location
*
Home
Nursing Home
Rehab/Skilled Nursing
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Display & Report Notice
Member Prayer Requests are displayed on Sundays for Two Weeks (Bereavement & Surgery for Four Weeks) and simultaneously All Requests become a part of our Prayer Ministry’s Prayer Report for 6 months. For any questions please contact the office or email care@theluke.org
If you desire to not have your name displayed on Sunday, Click the box below
Do Not Display
Submit your request and check your email for correspondence from the Care Ministry of The Luke Church.
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