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Request: Prayer
Request: Home Visitation
Notify: Hospital Admission
Notify: Scheduled Surgery
Notify: Passing of a Loved One
Click here to Request:
Baptism
Baby Dedication
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.
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.
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.
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.
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.
Name
*
First Name
Last Name
Email
example@example.com
Phone Number
*
10 digit Phone Number
Are you a member of The Luke Church?
*
Yes
No
Prayer Request
*
Please let us know how we may pray for you.
Would you like to receive a phone call for prayer?
*
Yes
No
Who is Homebound or Hospitalized?
*
I Am
A Loved One
Name of person Homebound or Hospitalized
*
First Name
Last Name
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
Are there Children (6-11) or Youth (12-18) in the deceased or your household?
*
Yes - Children
Yes - Youth
Yes - Both
No
Unsure
Date of Death
-
Month
-
Day
Year
Date
Do you have funeral arragements?
Yes
No
Are you considering The Luke for the service?
*
Yes
No
Date or Proposed Date of the Service?
-
Month
-
Day
Year
Date
Scheduled Date of Admission/Procedure
*
-
Month
-
Day
Year
Date
Hospital
*
Name of Homebound
*
First Name
Last Name
Location
*
Home
Nursing Home
Rehab/Skilled Nursing
Address
*
Street Address
Apt, Unit or Room #
City
State / Province
Postal / Zip Code
Funeral Home (Name & Phone Number)
*
Enter Funeral Caring for your Loved One
Please provide service details
*
Enter: Service Date, Location, Time
Please share any pertinent information regarding illness or condition
Include this Prayer Request in the 1st Wednesday Prayer Experience Submissions?
*
Yes
No
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
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